10 January 2018
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an unannounced comprehensive inspection at Chiltern House Medical Centre in High Wycombe, Buckinghamshire on 18 and 24 October 2016. The overall rating for the practice was inadequate. We used our enforcement powers to take action against the breaches of regulations including issuing three warning notices. We placed the practice in special measures to enable the practice to improve. The significant levels of concern led to three conditions being added to the registration of the practice. The conditions were imposed to ensure timely and sustainable improvement was made.
We undertook a second comprehensive inspection on 6 June 2017. This inspection was undertaken to determine whether the breaches of regulation requirements had been addressed following the inspection in October 2016. Whilst improvements had been made in relation to some of the concerns highlighted at the last inspection, there were areas relating to providing safe, effective, caring and well-led services which constituted continued breaches of regulations. The overall rating of the practice remained as inadequate, specifically inadequate for the provision of safe, effective, caring and well-led services. The practice was rated good for providing responsive services. The issues identified at the inspection impacted the care provided to all population groups which were also rated as inadequate.
We carried out an announced comprehensive inspection on 10 January 2017. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Chiltern House Medical Centre meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
At this inspection in January 2018 we found that significant improvements had been taken to improve the provision of care and treatment. Overall the practice is now rated as good.
Following the January 2018 inspection, the key questions are rated as:
- Are services safe? – Good
- Are services effective? – Good
- Are services caring? – Good
- Are services responsive? – Good
- Are services well-led? - Good
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
- Older People – Good
- People with long-term conditions – Good
- Families, children and young people – Good
- Working age people (including those recently retired and students – Good
- People whose circumstances may make them vulnerable – Good
- People experiencing poor mental health (including people with dementia) - Good
Our key findings at this inspection were as follows:
- It was evident the practice had gone through a period of transition including the implementation of a new management team. Positive changes had been made to the leadership team. The managing GP partner had a more active role in the management and leadership of the practice. Staff we spoke with recognised the endeavours of the new leadership team and were keen to be part of the new developments.
- The practice now had a clear vision that had improvement of service quality and safety as its top priority. The practice fully embraced the need to change, high standards were promoted and there was good evidence of team working.
- Significant improvements to risk management had been made and risks to patients were now being assessed and managed. This included concerns from the previous inspections.
- Staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention. For example, there was a comprehensive sepsis decision support tool. Sepsis is a rare but serious complication of an infection. Without quick treatment, sepsis can lead to multiple organ failure and death. We saw there was a proactive approach to anticipate and manage the risk of sepsis.
- Improved systems now ensured patients received timely reviews where treatment or interventions may be required. This included a review of pathology results (pathology is the medical speciality relating to the diagnosis of disease based on the laboratory analysis of bodily fluids such as blood and urine), a review of patients on more than four repeat medicines and annual health checks for patients with learning disabilities.
- Data showed most patient outcomes were similar when compared to local and national averages. The practice reviewed and monitored patient outcomes through the use of a clinical effectiveness plan which planned appropriate actions to identify and improve patient’s health and well-being.
- Revised systems to seek, act and monitor feedback. The practice had undertaken various actions to identify and act on patients' concerns reflected in the July 2016 national GP survey and more recently the July 2017 national GP survey. Feedback from patients relating to access to services and the quality of care had improved. This was corroborated by written and verbal feedback collected during the inspection.
The areas where the provider should make improvements are:
- Continue to improve patient recall and reviews for patients with a learning disability. Specifically, increase uptake for patients with a learning disability attending or having a completed health check.
- Continue to seek feedback and improve engagement with patients whilst reviewing the outcomes of patient feedback including patient surveys to determine appropriate action with a view to improving the patient experience.
- The leadership team should continue to review and sustain the improvements made to the overall governance and management of the practice.
I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice