Archived: Dr De & Dr A Ghosh Brace Street Health Centre Also known as Dr S De & Dr A Ghosh

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Dr De and Dr A Ghosh Brace Street Health Centre Practice on 20 October 2014. The practice is partnership of two GPs providing primary medical services for a population of approximately 3000 patients. The practice serves a diverse population in one of the most deprived areas in the country.

We found that the practice was responsive but needed to improve to deliver a safe, effective, caring and well-led service. We rated the practice overall as requires improvement.

Our key findings were as follows:

• Systems in place were not robust to ensure patients received a safe service. Potential risks to performance and patient safety (including those relating to health and safety, infection control, safe staffing, equipment and medicines) were not well managed.
• The practice did not have effective processes in place to drive service improvements and performance for patient outcomes.
• Feedback from patients about the service were mixed in their experiences of care and treatment received. Although most patients spoke positively of the service there was some scope for improvement. There had been efforts by the practice to improve the customer services aspect of care and maintain privacy which had been noticed by some patients.
• The practice was responsive to the needs of its patients. Patients expressed satisfaction with the appointment system. They were able to make an appointment easily and if needed could get urgent appointments the same day. The practice was accessible to patients with mobility difficulties.
• The practice did not demonstrate clear leadership and direction. The governance arrangements were not clearly defined so as to effectively manage risks and performance.

However, there were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure staff undertaking chaperoning duties have a clear understanding of their role and duties in order to appropriately support the patient during examination.
• Ensure that effective governance arrangements are in place for monitoring and managing potential risks to patients’ safety and performance relating to patient outcomes. This would include the issues relating to health and safety, staff recruitment and staffing levels, maintenance of equipment and medicines.

In addition the provider should:

• Strengthen the processes for managing information relating to patient safety and care. For example incidents, safety alerts, national guidance, audits complaints and comments and performance data to ensure that action needed is clearly identified and carried out to deliver improved patient outcomes.
• Introduce formal arrangements to ensure the needs of patients with complex and end of life care are discussed with relevant health and care professionals and co-ordinated care is delivered. This should include sharing information where appropriate with other providers such as the out of hours services to ensure patients receive continuity of care.
• Ensure staff understand their responsibilities under the Mental Capacity Act 2005 and their duties in fulfilling it.
• Establish systems to support patients who have recently suffered bereavement.
• Improve systems to support people who may be more vulnerable to access primary medical services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice