Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Bearwood Medical Centre on 4 March 2015. Overall the practice is rated as requires improvement.
Specifically, we found the practice to require improvement for providing safe ,effective and well-led services. We found the service to be good for providing caring and responsive services.
The areas for improvements that led to these ratings also applied to all of the six population groups that we inspected and which are also rated as requires improvement. These were, people with long term conditions, families, children and young people, working age people, older people, people in vulnerable groups and people experiencing poor mental health.
Our key findings across all the areas we inspected were as follows:
- Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed, with the exception of legionella, risks associated with the premises, responding safely to a medical emergency and staff with portable DBS checks.
- There were effective arrangements in place to identify, review and monitor patients with long term conditions. However, we saw out of date clinical polices and no evidence that NICE guidance was discussed in clinical meetings to share best practice. Staff were not confident in using the clinical system and information was sometimes recorded outside the system which did not allow a clear audit trail.
- Patients said they were treated with dignity and respect and they were involved in their care and decisions about their treatment. However, patient feedback from the 2014-2015 national GP patient survey showed areas where the practice needed to improve.
- The practice was responsive to the needs of the practice population. There were services aimed at specific patient groups for example, there were vaccination clinics for babies, children and those in high risk groups and women were offered cervical cytology screening. The practice acted on complaints raised and learning was shared with staff.
- There was visible leadership with defined roles and responsibilities and staff felt supported by the management team. However, the governance arrangements at the practice was not robust as not all essential risks had been assessed and managed.
We saw one area of outstanding practice:
- The practice proactively followed up vulnerable patients who did not attend (DNA) their appointment which included liaising with other agencies for example the police where it may be considered that a patient may be at risk for example, if their DNA was out of character.
However, there are also areas of practice where the provider needs to make improvements.
Importantly, the provider must:
- Have robust systems in place for the management of risks to patients and others against inappropriate or unsafe care. This must include completion of risks assessments in areas such as legionella, risks associated with the premises, responding safely to a medical emergency and staff with portable DBS checks.
- Fully train staff on utilising the clinical system to ensure patient information is managed safely and effectively.
In addition the provider should ensure that:
- Care and treatment records reflect national guidance such as NICE and there are arrangements to share best practice with staff.
- Training is provided for staff on the Mental Capacity Act to ensure staff are up to date with the regulation.
- Feedback from the 2014-2015 national GP patient survey is reviewed and acted on to improve patients experience of the service.
- Patient identifiable information is stored securely at all times.
- Actions are taken so that reasonable adjustments are made to enable people who require the use of a wheelchair are able to access the service.
- A risk assessment is carried out regarding the position of the baby changing unit to ensure safety and hygiene.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice