Stifford Clays Medical Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stifford Clays Medical Practice on 17 December 2015. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise safety concerns, and to report incidents and near misses. Issues raised were effectively analysed. Learning from the analysis of safety events and complaints was not being routinely shared with staff.
• Information about services and how to complain was available and easy to understand.
• Complaints were handled effectively but learning was not always routinely cascaded to staff. Complainants received an acknowledgement and an explanation.
• Some risks to patients were assessed and well managed. Those relating to health and safety, staff acting as chaperones without disclosure and barring service checks and the risks to staff of hepatitis B were not effectively managed.
• Not all staff had received an appraisal and some documentation was not readily available during our inspection so we were unable to confirm the qualifications, skills and experience of staff. Some staff members had not received training in CPR and safeguarding.
• Data showed patient outcomes were in line with other practices locally and nationally. Audits were being used to drive improvement in performance and to improve patient outcomes. The practice tailored its services to meet the needs of the practice population groups.
• Some staff had not received training in the Mental Capacity Act 2005 relevant to their role. This also included Gillick competency in relation to children under the age of 16.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about the services provided was readily available for patients.
• Urgent appointments were usually available on the day they were requested.
• The practice had a number of policies and procedures to govern activity and staff were aware of their roles and responsibilities.
• The practice had proactively sought feedback from patients and had an active patient participation group that had made positive contributions to the improvement of services provided at the practice.
• There was a clear leadership structure and staff felt supported by management. However the partners at the practice were not providing sufficient oversight of governance issues and staff spoken with were not aware of the vision and objectives of the practice.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

The Patient Participation Group (PPG) provided an outstanding contribution at the practice. In particular;

• They worked with a local school to provide free Christmas meals for patients likely to be alone at Christmas.
• They conducted a themed survey of prescription medicine wastage and worked with the practice and local pharmacies to provide patient education, improved efficiencies in prescribing, safer disposal of medicines and improving value for money.
• They obtained a grant for materials used at a knitting group for the patients at the practice.
• They worked with the local council to provide improved access to the surgery through the widening of a path outside the surgery.
• They sourced bookcases and books so that adults and children could borrow and return reading material free of charge.
• They attended the practice frequently during surgery hours to support patients to use the automated check-in appointment screen and to encourage patients to complete the NHS Friends and Family feedback forms.
• They monitored the improvement ideas left by patients in a suggestion box and worked with the practice to implement them.
• They liaised with external support agencies to achieve services and support for their patients.
• They attended area locality Clinical Commissioning Group meetings to be aware of issues affecting the practice and provided support and guidance for new PPGs being formed at other practices.

The areas where the provider must make improvements are:

• Ensure that there is an effective governance system in place to identify and mitigate the risks to patients and staff in relation to risk assessments, infection control, DBS checks for chaperones, the cascading of learning from significant events and complaints to relevant staff, the monitoring and review of staff training and that records in relation to the carrying out of services are readily available to view.
• Ensure that all staff receive appropriate training, supervision and appraisal.

The areas where the provider should make improvement are:

• Ensure that cleaning checklists currently in use are being completed by staff responsible for cleaning at the practice.
• Share the vision and objectives of the practice with staff. Improve the flow of communication amongst staff so that they are more aware of the issues affecting the practice.
• Ensure that Patient Group Directions are signed by the authorising manager.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice