Archived: Sai Medical Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sai Medical Practice on 21 March 2017. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. Lessons were shared with clear evidence of actions taken to improve safety in the practice.
• The practice had clearly defined and embedded systems in some areas to minimise risks to patient safety. Although, during the inspection the practice was unable to demonstrate an effective system for disseminating actions taken following the receipt of safety alerts, we saw that safety alerts were managed centrally.
• We identified issues relating to the management of some patients on high risk medicines where prescriptions had been authorised without evidence of a completed review of patients’ blood results.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• The practice carried out annual health reviews; however, there were some areas where staff were not effectively utilising care plan templates or attending palliative care meetings. The practice did not have systems for routinely reviewing unplanned hospital admissions.
• Data showed patient outcomes were below local and national averages in a number of clinical areas. The practice was aware of this and was actively addressing identified issues.
• Clinical audits had been carried out, we saw evidence that audits were driving improvements to patient outcomes in the areas identified.
• Results from the July 2016 national GP patient survey showed patients were involved in their care and decisions about their treatment. However, survey results showed that patients’ satisfaction relating to GP consultations, accessing care and treatment was mostly below local and national averages. The practice used a variety of methods to monitor and measure patient satisfaction such as mystery patient shoppers and the practice took action such as implementing a new telephone system and reviewing their appointment system to improve access.
• Patients who completed a Care Quality Commission comment card said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The practice had policies and procedures to govern their activities. However, there were areas where governance arrangements were not effectively operated to ensure the quality of care was assessed, monitored and risks mitigated.

We saw one area of outstanding practice:

• The practice understood their population profile and used this understanding to meet the needs of their population. For example, clinicians attended the local Mosque and the local homeless centre to encourage the uptake of flu vaccines during the seasonal flu campaign.

The areas where the provider must make improvement are:

• Establish effective systems to ensure the practice follows good practice guidance and adopt control measures to ensure arrangements are in place to respond appropriately and in good time to prevent unplanned admissions.

• Ensure oversite and governance of performance are carried out effectively and take proactive steps to identifying and address areas of lower performance. For example, in relation to patient satisfaction and areas of high exception reporting.

The areas where the provider should make improvement are:

• Develop an internal system to ensure actions taken in relation to patient safety alerts and medicines alerts from the Medicines and Healthcare products Regulatory Agency (MHRA) are recorded and disseminated throughout the practice.

• Continue to consider ways of encouraging the uptake of national screening programmes such as cervical, bowel and breast cancer.

• Continue exploring and establishing effective methods to identify carers in order to provide further support where needed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice