Meanwhile Garden Medical Centre: A case study in improvement

What we found in July 2015

• Patients were at risk of harm because systems to keep people safe were inadequate, including incident reporting, safeguarding, recruitment, infection control and medicine management.
• There were no systems to monitor safety and respond to risk.
• Although the practice carried out investigations when things went wrong, any lessons learned were not communicated, therefore safety was not improved.
• The practice did not have an automated external defibrillator (for cardiac emergencies) and had not assessed the risks of not having this equipment.
• There was no business continuity plan to deal with a range of emergencies that may impact on the daily operation of the practice and no buddy arrangements with other local practices.

What we found in April 2016

• There was an open and transparent approach to safety and an effective system for reporting and recording significant events.
• There was an effective system for reporting and recording significant events.
• When things went wrong, patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
• Risks to patients were assessed and well managed.
• Systems, processes and practices to keep patients safe and safeguarded from abuse were clearly defined and embedded.

What we found in July 2015

• Leadership was fragmented and there was no clear leadership structure.
• Staff told us they were not clear about their responsibilities in relation to the vision or strategy.
• There was little evidence of practice meetings and issues were discussed informally.
• Staff told us they had not received regular performance reviews and did not have clear objectives.
• The practice had not proactively sought feedback from staff or patients and did not have a patient participation group (PPG).

What we found in April 2016

• 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 practice had a clear vision to deliver high quality care and promote good outcomes for patients
• There was a mission statement and staff knew and understood the practice's values
• Staff assessed patients’ needs and delivered care in line with current evidence-based guidance
• Staff had been trained so that they had the skills, knowledge and experience to deliver effective care and treatment.

What we found in July 2015

• Patients said they sometimes had to wait a long time to be seen.
• The practice did not actively engage with patients and staff to gather feedback.
• The practice had not reviewed the needs of its local population.
• There was limited engagement with the clinical commissioning group (CCG) to discuss service improvements for patients.
• Although there was information for patients about how to complain it did not explain the process properly.

What we found in April 2016

• Patients said it was easier to make appointments.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• Information about services and how to complain was available and easy to understand.
• The quality of care improved as a result of complaints and concerns being acted on.
• The practice helped vulnerable patients to find out how to access various support groups and voluntary organisations.