Archived: Silverlock Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Silverlock Medical Centre on 21 July 2016. The practice was rated good overall and requires improvement for safe. The full comprehensive report from this inspection can be found by selecting the ‘all reports’ link for Silverlock Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced desk-based review carried out on 10 May 2017 to confirm that 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 21 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At our previous inspection undertaken on 21 July 2016 , we rated the practice as requires improvement for providing safe services and issued a requirement notice for breaches of regulation 12 of the Health and Social Care Act Regulations 2014 as:

• The practice did not have systems in place to monitor the professional registrations of clinical staff.

• Not all staff had completed essential training in accordance with recommendations and guidelines.

• Risks associated with the spread of common communicable diseases, fire, legionella, equipment and emergencies had not been adequately assessed and mitigated.

In addition to the breaches in regulation we suggested the practice should take the following actions:

• Put processes in place to regularly review and update practice policies.

• Include local safeguarding contacts and practice leads within the practice’s safeguarding policy.

• Improve uptake of breast screening and review procedures used to identify patients with

Coronary Heart Disease.

• Introduce a programme of quality improvement which focuses on improving clinical care.

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

• Undertake appraisals for all salaried staff.

The practice is now rated as good for the key question: Are services safe?

Our key findings were as follows:

• The practice had put in place a system to ensure that regular checks of professional registrations were undertaken.

• Staff had completed essential training in accordance with recommendations and guidelines including fire safety and infection control.

• The practice had complied with the recommendations in their legionella risk assessment.

• All electrical equipment had been tested to ensure that it was safe to use.

• The practice provided evidence that staff had either been vaccinated against common communicable diseases or supplied risk assessments to justify the absence of immunisations for certain members of staff.

• The practice had a full complement of emergency medicines which reflected current guidelines and their business continuity plan contained contact information for all members of staff.

In addition:

• The practice sent us a sample of policies demonstrating that reviews were being completed on a regular basis. The practice’s safeguarding policies for adults and children identified the practice leads and contained information for external contacts within the community.

• The practice told us that they were using a new breast screening alert on their clinical system to alert clinicians to patients who were eligible for breast screening. The practice also informed us that they provided leaflets both in the surgery and on their website. The practice informed us that they would actively contact patients who failed to attend for their breast screening appointment. There had been an increase in the percentage of females aged 50-70 screened for breast cancer in last 36 months from 48% at our last inspection to 55%. However this was still below the local average of 63% and the national average of 73%.

• The practice told us that they were using computer software to increase the identification of patients with coronary heart disease (CHD) and provided a search of patients prescribed clopidogrel (medication given to patients who have had a heart attack) where there was no diagnosis of CHD noted on their records.

• The practice provided evidence of improved clinical performance assessed against key performance indicators set by the Clinical Commissioning Group (CCG) in respect of administration of flu vaccinations and management of long term conditions. All areas assessed showed improvement between 2015/16 and 2016/17 For example patients with hypertension who had blood pressure readings within target range had increased by 7% and the numbers of pregnant women who received a seasonal flu vaccination had increased by 25%. The practice had improved performance in these areas by employing a pharmacist to assist with management of patients with long term conditions and upskilling a receptionist to become a healthcare assistant who delivered 349 flu vaccinations in the last flu season.

• The practice informed us that they had increased the number of patients on their carers register by 15 patients to 52 (0.8%). The practice had used their seasonal flu campaign to identify patients who act as carers and held an open day in October 2016 which was attended by a local carers support organisation.

• The practice provided evidence that internal appraisals were being undertaken for salaried clinical staff working at the practice.

However, there were still areas of practice where the provider should make improvements.

The provider should:

• Continue to review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

• Continue work to improve uptake of breast screening.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice