Royal Arsenal Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Royal Arsenal Medical Centre on 26 July 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 staff understood their responsibilities to raise concerns and report incidents and near misses. However, records of investigations and correspondence were not always kept and there was no evidence of learning and communication with staff as meetings were not minuted.

• Patients were at risk of harm because systems and processes were not always in place to keep them safe. For example, there was no failsafe process in place to ensure that results for all specimens taken for cervical cytology had been received and there was no formal system in place to monitor the rate of inadequate specimens sent for analysis.
• Health and Safety and Legionella Risk Assessments had not been carried out since moving to the current premises in 2012.

• The registration status of professional staff had not been checked prior to employment and there were no monitoring processes in place to ensure that registration revalidation was maintained.

• Performance data showed that patient outcomes were comparable to local and national averages.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said urgent appointments were generally available the same day but they found it difficult to make a routine appointment or an appointment with a named GP and there was a lack of continuity of care.
• Information about services and how to complain was available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs with the exception of some emergency medicines.
• The practice had a number of policies and procedures to govern activity. However, the practice did not have a Business Continuity Plan in place and did not follow the appropriate procedure for incident reporting.
• 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. However there was currently only one member of the patient participation group (PPG).

There were areas where the provider must make improvements:

• The provider must ensure that all necessary emergency medicines are available for use if required.

• The provider must investigate all safety incidents and complaints thoroughly, ensuring records are kept of all investigations and correspondence undertaken. Records should also be kept of learning identified and shared with staff.

• The provider must ensure that recruitment and staff management arrangements include the checking of registration status of all professional staff and the monitoring that revalidation is current.

• The provider must ensure that all current Patient Group Directions are signed by both the authoriser and the practitioner.

• The provider must ensure that the content of Patient Specific Directions (PSDs) comply with the required criteria for PSDs.
• The provider must ensure that a Health and Safety Risk Assessment and Legionella Risk Assessment are carried out.
• The provider must ensure that annual appraisals are undertaken for all staff.

There were areas where the provider should make improvements:

• The provider should ensure there is an effective system to record and share key content and learning from meetings.
• The provider should review current staffing arrangements to improve continuity of care and the availability of non-urgent appointments.
• The provider should produce a Business Continuity Plan to include practice arrangements for responding to emergencies and major disruptions to the service such as power failure or building damage.
• The provider should consider proactive strategies to encourage patients to join the patient participation group (PPG).
• The provider should implement a failsafe process to ensure that results for all specimens taken for cervical cytology have been received and to monitor the rate of inadequate specimens sent for analysis.
• The provider should record batch numbers of blank electronic prescriptions placed in individual printers.
• The provider should implement a failsafe process to ensure patients receiving high risk medicines are reviewed as appropriate.
• The provider should review ways to improve patient satisfaction with regards to access to routine appointments.
• The provider should consider ways of reducing the Quality Outcomes Framework exception reporting rate.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice