Sheppey Healthy Living Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sheppey Healthy Living Centre on 20 June 2017. The overall rating for the practice was requires improvement. The full comprehensive report from the 20 June 2017 inspection can be found by selecting the ‘all reports’ link for Sheppey Healthy Living Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 16 November 2017 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 20 June 2017. 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.

Our key findings were as follows:

• There was a system for receiving and acting on safety alerts. The practice learned from patient and medicine safety alerts.
• There were systems to monitor patients on high risk medicines.
• The repeat prescribing policy had been updated. Patients who did not collect their prescriptions were contacted and the clinician was informed.
• The process to record significant events had been updated and provided an audit trail of actions taken and outcomes of investigations.
• The process to record complaints had been strengthened to include verbal complaints. Lessons were learned from individual concerns and complaints and also from the analysis of trends.
• The practice had identified 38 patients as carers (1.4% of the practice list). Written information was available to direct carers to the various avenues of support available to them.
• The practice had reviewed the needs of patients to ensure services were accessible. As a result of this review the practice was planning to provide a patient leaflet in Polish.
• A hearing loop was available at the practice.
• The practice had a process to assess whether a home visit was clinically necessary; and the urgency of the need for medical attention. In cases where the urgency of need was so great that it would be inappropriate for the patient to wait for a GP home visit, alternative emergency care arrangements were made. Clinical and non-clinical staff were aware of their responsibilities when managing requests for home visits.
• The practice had a policy for patients who did not attend appointments. Patients were sent a reminder 48 and 24 hours prior to their appointment. Patients who failed to attend appointments were contacted and the practice kept a record of why patients did not attend. This information was used for learning to improve accessibility.
• The practice had a patient participation group which had two members. The practice made efforts to attract additional patients to the forum. To increase opportunities to collect patient feedback and communicate with patients the practice had set up a virtual patient group which had 61 members.

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 Sheppey Healthy Living Centre on 20 June 2017. Overall the practice is rated as requires improvement.

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

• We found there was a system for reporting and recording significant events. However, the management of incidents was not consistently timely and some incidents lacked investigation, analysis and learning to support improvements. When things went wrong patients were informed as soon as practicable, received reasonable support, truthful information, and a written apology.
• The practice did not have defined and embedded systems and processes to minimise risks to patient safety. There was an absence of management oversight and a reliance of the professionalism of individuals to recognise and respond to risks.
• We found improvements were required to ensure the consistently safe prescribing and monitoring of medicines.
• In 2015/2016 the practice achieved 97% of the points available under the Quality and Outcome Framework.
• Clinical audits demonstrated quality improvement and were scheduled to be repeated to check changes had been embedded into practice.
• The practice provided a range of services in partnership with health and social care services to meet the needs of their patient population. For example, an external organisation attended the practice weekly to assist vulnerable and homeless patients.
• Information about how to complain was available. We saw the practice responded in a timely and appropriate manner to concerns raised but needed to strengthen their recording systems.
• The practice had an induction process in place and staff had received appraisals and training but the staff records were not always reflective of this.

The areas where the provider must make improvement are:

• Ensure all that is reasonably practical is done to mitigate the risks to patients, through the timely actioning of safety alerts and proper and safe management of medicines.
• Ensure systems or processes are established and operating effectively to assess, monitor and improve the quality and safety of the services through embedding governance, improving the recording, investigation and learning from significant incidents and complaints and maintain securely records of training and appraisal for their staff.

The areas where the provider should make improvement are:

• Ensure cleaning documents are reflective of actions undertaken.
• Ensure appropriate emergency medicines are available.
• Ensure the practice retains evidence of staff reviews and appraisals conducted.
• Improve the identification of carer’s
• Ensure an effective complaints system operates to evidence the management of verbal complaints.
• Conduct a patient need assessment to ensure services are accessible e.g. for patients with hearing or sight impairments.
• Immediately alert the GP that a home visit request has been received.
• Ensure a policy is in place for patients who repeatedly fail to attend appointments and ensure the practice follows up on their care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice