Darlaston Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Darlaston Medical Centre Dr Ali Surgery on 9 August 2016. 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 an effective system in place for reporting and recording significant events. However, the recording and analyses of investigations were not thorough enough. For example, although lessons learned and actions to mitigate risks of further incidents was discussed during practice meetings completed incident forms did not include subsequent actions the practice intended to take to reduce the risk of recurrence.

• Safeguarding policies and processes were in place however, they were not consistently followed. For example, the practice process for following up children who had not attended hospital appointments was not always followed.

• Some systems were in place to assess and manage risks to patients, with the exception of risks associated with the premises; and in the absence of some medicines to treat certain medical emergencies the practice had not carried out a risk assessment.
• Patients in receipt of medicines, which required closer monitoring, were not always receiving a review of their treatment in line with prescribing recommendations.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. Staff had access to training and support to ensure they maintained the required skills, knowledge and experience.
• Clinical audits demonstrated sustained quality improvement and the practice participated in local pilots.
• The national GP survey showed patients’ responses varied on some aspects of care. Patients spoken with on the day said they were treated with compassion, dignity and respect. Patients felt involved in their care and decisions about their treatment. Completed Care Quality Commission comment cards were consistent with these views.
• On the day of the inspection patients 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. However, the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was below the national average.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.

The areas where the provider must make improvement are:

• In the absence of some emergency medicines, the practice must carry out a risk assessment in order to mitigate potential risks.
• Implement an effective system to improve the monitoring of high-risk medications and ensure reviews are carried out as part of, and align with, patients care and treatment plans and published guidance.
• Ensure the practice safeguarding procedures are followed to ensure where appropriate staff are following up children who had not attended hospital appointments.
• Establish and operate an effective system to assess, monitor and mitigate risks relating to the health, safety and welfare of service users and others who may be at risk, which arise from the carrying on of the regulated activity. For example, the practice must gain assurance that an appropriate legionella assessment and identified actions has been carried out.

The areas where the provider should make improvement are:

• Consider how clinical audit cycles may further improve patient outcomes.
• Continue to liaise with the property owners to gain assurance that identified building repairs are carried out to completion.
• Continue reviewing the uptake of childhood immunisations and consider ways to further promote.
• Consider how in the absence of a hearing loop they ensure effective communication with patients with hearing difficulties.
• Consider how maintaining a record of verbal complaints and recording actions taken can support further learning.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice