Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Waters Edge Medical Centre on 4 October 2017. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However clinicians were not meeting to discuss learning outcomes and actions and therefore, relevant information was not being disseminated to the locum GPs working at the practice.

• Not all risks to patients were assessed and managed.For example, those relating to staff recruitment checks, some health and safety checks and the summarising of new patient medical records and the lack of an effective recall system for patients with long-term conditions.

• Staff were aware of procedures for safeguarding patients from the risk of abuse, however improvements were needed with regard to the information recorded in patient records.

• The practice was experiencing significant staffing issues and was reliant on locum GPs and advanced nurse practitioners to provide services to patients.

• The systems to monitor the training needs of staff were not effective and the system to ensure appraisals and staff personal development plans were carried out required improvement.

• The overarching governance of the practice was ineffective and did not support the monitoring of the quality and safety of the service.

• The electrical wiring system had not had a periodic check carried out to ensure it was safe.

• Staff were aware of current evidence based guidance.

• Patients said they were treated with compassion, dignity and respect. We saw staff treated patients with kindness and respect.

• Services were planned and delivered to take into account the needs of different patient groups.

• Information about services and how to complain was available. However, improvements were needed to ensure robust records were maintained to support learning and openness and transparency.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice sought feedback from staff and patients, which it acted on.

• The provider was aware of the requirements of the duty of candour.

The provider needs to make improvements.

Importantly, the provider must:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. In particular with regard to health and safety and systems and processes such as a periodic check of the electrical wiring system, long- term conditions recall system and safeguarding.

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

In addition the provider should:

• Review the safeguarding system to ensure complete and detailed information is recorded in patients records Continue to monitor the effectiveness of the meetings set up with other health and social care professionals with regard to safeguarding.

• Put a system in place to ensure patients with long-term conditions are effectively monitored at regular intervals.

• Regularly monitor the newly implemented fire safety systems to maintain staff and patient safety.

• Introduce a system to allow the findings and actions arising from investigations into significant events to be consistently shared with staff. Record the action taken and date of review of all significant events to allow a comprehensive overview of issues arising and actions implemented.

• Review the complaints system to ensure accurate records were maintained and actions taken clearly recorded.

• Review the system in place that monitors the health and wellbeing of patients with mental health needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice