This practice is rated as Good overall. (Previous rating October 2017 – Good)

The key questions at this inspection are rated as:

Are services responsive? – Good

We carried out an announced focused inspection at York House Medical Centre on 9 October 2018. This was to follow up on a breach of regulations identified at our previous inspection. At our previous inspection on the 2 October 2017 we found that the provider had not acted on patient feedback regarding difficulty accessing appointments or completed the practice action plan submitted to CQC following their inspection in July 2016. The details of these can be found by selecting the ‘all reports’ link for York House Medical Centre on our website at www.cqc.org.uk.

At this inspection we found:

• The practice had completed their action plan and implemented changes to both the telephone and appointment systems.
• Skill mix at the practice had been increased by employing a practice pharmacist and introducing minor illness appointment with a nurse practitioner.
• The practice had continued to develop communication within the practice and with other stakeholders.
• Significant events were discussed at clinical and staff meetings to ensure learning was shared appropriately.
• The practice had reviewed the range of medicines held on site to deal with medical emergencies and introduced a new system for checking these.

The areas where the provider should make improvements are:

• Take action to review the impact of changes made in response to patient feedback about accessing care.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at York House Medical Centre on 7 July 2016. The overall rating for the practice was requires improvement. Specifically, we found the practice to require improvement for the provision of safe and responsive services. The practice was rated good for providing effective, caring and well-led services. The concerns identified as requiring improvement affected all patients and all population groups were also rated as requires improvement. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for York House Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 23 August 2016 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 7 July 2016.

This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good. However, provision of responsive services remains rated as requires improvement.

Our key findings were as follows:

• The process for reporting significant events had improved to include an online reporting form. Sharing of learning from significant events had expanded to include the practice nurses and salaried GPs. However, not all events were shared with the non-clinical staff.
• Legionella risk assessments had been carried out. Monitoring of water temperatures was carried out as a result of the assessment to reduce the risk of waterborne infections.
• Actions had been taken arising from the fire risk assessment. For example, we saw fire drills were undertaken and recorded.
• Monitoring of medicine fridge temperatures was undertaken consistently to ensure medicines requiring refrigeration were maintained within appropriate temperature ranges.
• All relevant pre-employment checks were being carried out before new staff joined the practice.
• There was a system in place to ensure blank prescriptions were stored and distributed for use in a secure manner.
• Minutes of staff meetings were recorded consistently and made available to staff via the practice computer network.
• Mandatory training had been completed by all staff. There was system in place to ensure training was completed at relevant intervals and training was available through a variety of sources.
• Feedback from patients taking part in the national patient survey in regard to accessing services was below average. The practice had not undertaken a review of the appointments system to review availability against demand.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition the provider should:

• Review the dissemination of learning from significant events to the wider practice team.
• Review the range of medicines held to deal with medical emergencies and consider the needs of all registered patients who may encounter a medical emergency.

At our previous inspection on 7 July 2016, we rated the practice as requires improvement for providing responsive services as feedback from patients in regard to access to appointments was below average. At this inspection we found that feedback from patients remained below average. The actions taken by the provider to address this were in the process of implementation and it was too early to evaluate whether these would result in improved patient feedback. Consequently, the practice is still rated as requires improvement for providing responsive services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at York House Medical Practice on 7 July 2016. Overall the practice is rated as requires improvement.

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

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. However, we noted that learning from these was not shared widely enough to support improvement.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. For example; recruitment checks; completion of actions identified by risk assessments, cold storage of medicines and training. Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they did not find it easy to make an appointment with a GP of their choice but there were urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

The practice provided specialist support to patients and their families who were affected by cancer. We saw evidence of how this service had helped and supported patients and patients said they felt empowered and were more prepared for hospital appointments, for example they knew which questions they wanted to ask.

The areas where the provider must make improvement are:

• Ensure training appropriate to job role is completed by all clinical and non-clinical staff and GPs, including fire safety, infection control and information governance.
• Ensure all significant events are recorded and learning from significant events is shared widely enough to support improvement.
• Ensure actions identified from risk assessments are completed and recorded. This includes actions from Legionella risk assessment.
• Ensure recruitment arrangements include all necessary employment checks for all staff in accordance with Schedule Three.
• Ensure that patient satisfaction including access to appointments and telephone access continues to be reviewed and improved.
• Ensure that medicines and vaccines are stored safely by appropriate monitoring of the temperatures of fridges used to store medicines and vaccines.

The areas where the provider should make improvement are:

• Review how blank prescription forms are stored and tracked within the practice to ensure it is in accordance with national guidance.
• Review how meetings are recorded to ensure that all team meetings are minuted.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice