Herschel Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Herschel Medical Centre on 23 November 2016. We carried out this inspection to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made.

Our previous inspection in May 2016 found breaches of regulations relating to the safe, effective and responsive delivery of services. There were also concerns and regulatory breaches relating to the governance and leadership of the practice, specifically in the well led domain. The overall rating of the practice in May 2016 was requires improvement. Specifically, the practice was rated require improvement for provision of safe, effective, responsive and well-led services in May 2016. It was good for providing caring service. Following the inspection, we received an action plan which set out what actions the practice would take to achieve compliance.

At the inspection in November 2016, we found the practice had made improvements since our last inspection in May 2016. Overall the practice is rated as good. Specifically, we found the practice good for providing safe, effective, caring, responsive and well led services.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Data showed the practice had demonstrated improvements in patient’s outcomes. Audits had been carried out and we saw evidence that audits were driving improvement in patient outcomes.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• The patients we spoke with on the day of inspection informed us they had noticed improvements in the availability of appointments.
• 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Continue to review and improve the waiting time it takes to get through to the practice by telephone.
• Review and monitor the system in place to continue encouraging the uptake for the bowel screening programme.

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 Herschel Medical Centre on 4 May 2016. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for provision of safe, effective, responsive and well-led services. It was good for providing caring service. The concerns which led to these ratings apply to all population groups using the practice.

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. The majority of information about safety was recorded, monitored and reviewed.
• Risks to patients and staff were assessed and well managed, with the exception of those relating to safeguarding adults training, safety alerts, staffing levels and appointment booking system.
• Data showed patients outcomes were low for patients with hypertension, diabetic patients, care plans for patients with learning disabilities and patients experiencing poor mental health, and medicine reviews for patients with long term conditions.
• We found that completed clinical audits cycles were driving positive outcomes for patients.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment. However, most staff had not completed health and safety, equality and diversity, fire safety, basic life support and infection control training.
• Results from the national GP patient survey showed majority of patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment when compared to the local and national averages. The majority of patients we spoke with on the day of inspection confirmed this.
• Information about services and how to complain were available and easy to understand.
• Patients said they found it difficult to make an appointment with a named GP and had to wait a long time to get through to the practice by telephone each morning. Urgent appointments were available the same day.
• The practice had excellent 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 provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Ensure all actions required in response to national safety and medicines alerts are completed and alerts are followed up systematically after they are disseminated within the practice, to monitor that required changes have been implemented.
• Review and improve the staffing levels to ensure the smooth running of the practice and keep patients safe.
• Review and improve the systems in place to effectively monitor patients with hypertension, diabetic patients, care plans for patients with learning disabilities and patients experiencing poor mental health, and medicine reviews for patients with long term conditions.
• Ensure all staff have undertaken training including safeguarding adults, health and safety, equality and diversity, fire safety and infection control.
• Consider patient feedback about the appointment system. Review the appointments booking system and the waiting time it takes to get through to the practice by telephone. Improve the availability of non-urgent appointments with a named GP.

In addition the provider should:

• Update procedures for checking medicines in GPs home visit bags.
• Review the system in place to promote the benefits of bowel screening in order to increase patient uptake.
• Review patients feedback and address concerns regarding GPs listening, explaining tests and treatments, and treating them with care and concern during consultations.
• Review the process of identifying carers to enable them to access the support available via the practice and external agencies.
• Ensure information posters and leaflets are available in multi-languages.
• Ensure extended hours appointments details are advertised on the practice website and displayed in the premises.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice