The Symons Medical Centre

Letter from the Chief Inspector of General Practice

This practice is rated as Good. (Previous inspection March 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at The Symons Medical Centre on 8 November 2017. This inspection was carried out as part of our new phase of inspections, which commenced on 1 November 2017. The practice had previously been inspected in March 2015 and was rated as good overall.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• Systems to identify, assess and manage risk were not always operated consistently. For example,the practice did not demonstrate awareness of The Electricity at Work Regulations that require a risk assessment of the electrical systems to determine their safety, the system to act upon safety alerts did not confirm actions had been completed, operational policies were not updated in line with the practice schedule and appropriate authorisation for nurses to administer immunisations was not completed in all cases.
• The practice GPs and nurses worked with other health professionals but records were not always kept of the meetings. Staff who were unable to attend the meetings would not be aware of decisions reached in regard to shared care and treatment.
• The practice had a system in place to identify carers and held a carers register. However, the number of carers registered was below 1% which did not reflect the number of carers identified in the last national census for the locality. The practice identified that the higher than average population of patients living in care homes might have affected the number of carers on their register
• The system for offering health reviews for patients with a learning disability was not operated effectively.

We saw two areas of outstanding practice:

• The practice recognised they had deaf patients registered and one of the GPs was learning British Sign Language to enable them to communicate with this group of patients.
• A joint audit project with local care homes on the benefits of appropriate hydration levels in elderly patients had resulted in fewer incidents of urinary tract infections.

The areas where the provider must make improvement as they are in breach of regulations is:

• Establish effective and consistently operated systems and processes to ensure good governance in accordance with the fundamental standards of care

The areas where the provider should make improvements are:

• To implement a system that enables identification of patients with caring responsibilities to facilitate provision of appropriate support to this vulnerable group.
• Confirm, the recently introduced, recall system to provide patients with a learning disability with an annual health check functions effectively.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice