Belmont Medical Centre

Letter from the Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Belmont Medical Centre on 25 January 2017. The practice was rated requires improvement for providing safe, effective and responsive services, good for providing caring services and inadequate for being well-led with an overall rating of requires improvement. The full comprehensive report on the inspection carried out in January 2017 can be found by selecting the ‘all reports’ link for Belmont Medical Centre on our website at www.cqc.org.uk.

On 24 August 2017 we carried out an announced, comprehensive follow-up inspection to confirm 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 25 January 2017. This report covers our findings in relation to those requirements.

We found the practice had carried out a detailed analysis of the previous inspection findings, and had made extensive changes which had resulted in significant improvements. A comprehensive action plan detailed the actions taken and the processes that had driven improvements since our previous inspection.

Our key findings were as follows:

• Risks to patients were assessed and managed through practice meetings and through discussions with the multi-disciplinary teams.
• The practice had clearly defined systems to minimise risks to patient safety.
• The structured, open and transparent approach to the reporting and recording of significant events and complaints had been maintained and further developed since our previous inspection. Six monthly analyses identified themes and trends. Staff were aware of and understood their responsibilities to report these. Learning was shared with staff at team meetings.
• Arrangements for managing medicines kept patients safe.
• Staff were aware of current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment, including regular training updates.
• The practice had appropriate arrangements to identify patients who were carers to enable them to receive care, treatment and support that meets their needs. They worked in conjunction with Herefordshire Carers Support agency to achieve this.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Patients’ satisfaction with how they could access care and treatment was lower than local and national averages according to the National GP Patient Survey results published July 2017. Patients told us they were happy with the arrangements and could always get appointments as they needed them.
• Information about services and how to complain was available in a range of languages. Improvements were made to the quality of care as a result of complaints, concerns and patient feedback.
• There was effective oversight, planning and responses to practice performance.
• 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.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Continue to encourage patients to engage in national screening programmes for breast and bowel cancer.
• Continue to strive to improve the patient experience around access to appointments.

The practice is now rated as good for providing safe, effective, caring and well-led services, and requires improvement for providing responsive services. The overall rating for the practice is now good.

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 Belmont Medical Centre on 25 January 2017. Overall the practice is rated as requires improvement.

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

• There was a system in place for reporting and recording significant events.
• We found that some patients were at risk of harm because systems and processes were not sufficiently in place to keep them safe. For example, monitoring of patients taking high risk medicines, action of patient safety alerts such as Medicines and Healthcare products Regulatory Agency (MHRA) and recruitment checks.
• Staff had access to guidelines from the National Institute for Health and Care Excellence.
• Whilst there was evidence of some quality monitoring to improve patient care, the practice had not implemented a structured programme of activity.
• Feedback from patients showed they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Data showed that whilst patients found accessing appointments could be difficult, they were able to see a preferred GP if required. There was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management. The practice reviewed feedback received, and took action to implement improvements.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Implement a co-ordinated approach for the review and action of patient safety alerts received within the practice; to ensure risks are effectively managed.

• Implement an effective system to ensure all patients prescribed with high risk medicines are regularly monitored.

• Ensure that all staff undertaking chaperone duties have received training. The provider must ensure compliance with its own assessment of risk, that all staff undertaking chaperone duties are subject to a DBS check.

• Ensures that it assesses and manages the risk of legionella.

• Ensure recruitment arrangements include all necessary employment checks for employees and locum staff working within the practice.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

• Ensure that a process for undertaking regular staff appraisals is implemented.

• Ensure that all nurses have undertaken training in the Mental Capacity Act 2005.

The areas where the provider should make improvement are:

• Review significant incidents recorded and investigated to ensure measures taken to improve systems and processes have been effective. Review should include whether staff learning has become embedded within the practice.

• Ensure that the remaining controlled drugs are disposed of in line with regulations and that the records are reviewed and updated.

• Assess whether children’s pads are required to be held with the defibrillator in the event of a patient emergency.

• To continue to identify carers as a low number of the practice list size had been identified.

• Continue to strive to improve the patient experience around access to appointments.

• To make contact with patients who have volunteered interest in joining the patient participation group. (PPG)

Where, as in this instance, a provider is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected no longer than six months after the initial rating is confirmed. If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice