Archived: Great Chapel Street Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Great Chapel Street Medical Centre on 19 May 2015. The overall rating for the practice was good with safe as requires improvement and responsive as outstanding. The full comprehensive report on the May 2015 inspection can be found by selecting the ‘all reports’ link for Great Chapel Street Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 11 January 2018 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 19 May 2015. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The previous issues were;

• Ensure all non-clinical staff has access to formal essential training such as safeguarding and basic life support.

• Ensure there is an audit trail for information received at the practice from hospital outpatient departments.

• Advertise the chaperone service to inform patients this service is available within the practice.

Overall the practice is rated as good.

Our key findings were as follows:

The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• All staff received up-to-date safeguarding and safety training appropriate to their role. They knew how to identify and report concerns.
• Staff who acted as chaperones were trained for the role and had received a DBS check, and posters advertising this were in the waiting room and consulting rooms.
• The practice conducted safety risk assessments. It had a suite of safety policies which were regularly reviewed and communicated to staff. Staff received training in basic life support and fire safety.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The waiting room was in need of decorating and the flooring needed replacing.

We saw several areas of outstanding practice:

• The practice provided an outreach service out of hours in which the practice nurse and the Social Advocacy Worker would access homeless shelters and search for homeless people on the street to reach people with complex needs who may find it difficult to engage with health and social care providers. 
• The outreach service led to the development of the Integrated Care Network (ICN) which has been adopted by the local authority and CCG. The purpose of the pathway was to intervene medically and socially to prevent the deterioration of medical or mental health conditions that might have led to a hospital admission. 

• The practice employed a Social Advocacy Worker who was available five days per week to provide patients with housing, benefits and employment advice. The Social Advocacy Worker assisted patients with job applications, represented patients at court hearings in relation to benefits sanctions and liaised with re-housing services to access temporary or permanent accommodation for patients.

• Practice staff provided training for staff working in other organisations for the homeless such as hostels in relation to monitoring of medicines and management of aggression.

The areas where the provider should make improvements are:

• Review the arrangements for staff appraisals to ensure that all staff receive them annually.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice