Archived: Great Homer Street Medical Centre

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Great Homer Street Medical Centre. The practice is registered with the Care Quality Commission to provide primary care services. We undertook a planned, comprehensive inspection on 7 October 2014 and we spoke with patients, relatives, staff and the practice management team.

The practice was rated as Requiring Improvement.

Our key findings were as follows:

• Safety

The practice is rated as requires improvement for safety as there are areas where improvements must be made. There was an open culture when reporting incidents but staff had not been trained. Systems were in place for children's safeguarding but they were not robust for adults. Safe arrangements were in place for medicines management. The GP’s undertook regular minor surgery without policies and procedures to support this. A number of concerns were identified relating to the unfit state of the premises. Appropriate pre-employment checks were not undertaken and completed before employment.

• Effective

The practice is rated as requires improvement for effective as there are areas where improvements should be made. Care and treatment was considered in line with current published guidelines and best practice but written patient consent was not sought for patients undergoing minor surgery. Audits were undertaken but there was a lack of evidence to show what action and learning had taken place. Staff had not received annual appraisals or regular supervision.

• Caring

The practice is rated as good for caring. We saw good compassionate care where patients were given time and support during their appointment. Feedback we received from patients before and during our inspection indicated they felt fully involved in their care.

• Responsive

The practice is rated as good for responsive. The practice reviewed the needs of their local population and engaged with the NHS Local Area Team (LAT) and Clinical Commissioning Group (CCG) to secure service improvements where these were identified. Patients reported good access to the practice. There was an accessible complaints system with evidence demonstrating that the practice responded quickly to issues raised.

• Well-led

The practice is rated as requires improvement for well-led as there are areas where improvements should be made. Staff we spoke with were clear about their working values and ethos and how important these were in working in an area of high deprivation. Staff felt supported, valued and motivated. We saw transparent and open governance arrangements but in parts they were not effective because systems were not in place to effectively manage staff and or identify, monitor and manage risks to patients and staff working at the practice. The practice proactively engaged the general public, patients and staff to gain feedback (PPG).

There were areas of practice where the provider needs to make improvements. 

Importantly, the provider must:

• Review the arrangements in place to ensure that people attending the practice are protected against the risks associated with unsafe premises. 

• Review the systems for assessing and monitoring the quality and safety of service provision and take steps to ensure risks are managed appropriately.

• Take action to ensure its recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 to ensure necessary employment checks are in place for all staff.

• Ensure that all staff have the necessary skills and competencies in relation to all aspects of their work and a written record of this is maintained. They must also ensure that all staff have access to a period of induction, supervision and annual appraisal and written records for these must be maintained.

In addition the provider should:

• Ensure alert notifications from national safety bodies are cascaded to all relevant staff and held at the practice.
• Take action to address infection prevention and control to ensure that they comply with the ‘Code of Practice for health and social care on the prevention and control of infection and related guidance’. In particular for the impact the increased infection control risks caused by the unfit premises.

• Review the systems and processes in place for the safeguarding of vulnerable adults.

• Ensure that written consent is sought for all patients undergoing minor surgical procedures in line with DOH guidance.

• Audits and reviews of services were taking place however the provider should ensure that actions and learning taking place following the results should be clearly documented.

• Review the system in place for reviewing all letters relating to blood results and patient discharge letters.

• Electronic patient summaries should be completed for all to ensure that if required by another provider, patients can receive healthcare faster, easier access for instance in an emergency situation or when the practice is closed.

• Review all policies and procedures to ensure they are up to date.

• Ensure minutes are taken for all clinical and practice meetings.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice