West Derby Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at West Derby Medical Centre on 24 April 2017. The overall rating for the practice was good with requires improvement for providing well led services. The practice was issued a requirement notice for being in breach of regulations for governance. The full comprehensive report for the 24 April 2017 inspection can be found by selecting the ‘all reports’ link for West Derby Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced follow up inspection carried out on 4 October 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 24 April 2017. This report includes our findings in relation to those requirements.

Overall the practice is rated as good and now good for providing well led services.

Since our last inspection, the practice had made some improvements towards the main issues identified. Improvements included:

• The completion of risk assessments for the control of substances hazardous to health (COSHH) and display screen risk assessments for staff.
• A log book for monitoring verbal complaints.
• A log book of prescriptions that were uncollected and destroyed.
• Medicine safety alert information was available on the front page of computer screens with a link for more information for clinicians to access. Safety alerts were discussed at clinical meetings.

In addition:-

• All staff had received safeguarding training and Mental Capacity Act training appropriate for their role.
• The appointment system had been reviewed and more on the day appointments had been introduced to reduce the number of failed appointments.
• The telephone system had been altered to make it easier for patients to get through to the practice.

However, some aspects of improvement were still in progress and the practice should:-

• Review GP national patient survey data and how the practice monitors patient satisfaction with regards to appointment and telephone access and take appropriate action when necessary.
• Record all verbal complaints, the action taken and review verbal complaints to identify patterns and trends.
• Have a separate mechanism for staff to record incidents.
• Review the new procedure for managing uncollected prescriptions to check whether it is working.
• Formally record a disability access risk assessment.
• Keep a log of incoming safety alerts and record the action taken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at West Derby Medical Centre on 24 April 2017. Overall the practice is rated as good but requires improvement for providing well led services and good for providing safe, effective, responsive and caring services.

Our key findings across all the areas we inspected were as follows:

• The practice had recently moved from two locations to a purpose built health centre. The practice was clean and had good facilities including disabled access to the main entrance, translation services and a hearing loop. However, there was limited car parking facilities. The practice was working towards trying to resolve this issue. Disabled access to the upper floor was poor, as there were two heavy doors to the entrance of the waiting room, and access to the toilet area would be very difficult in a wheelchair.
• Patient comments received indicated there were difficulties in getting through to the practice by telephone, waiting for an appointment with a GP of their choice and problems with prescriptions. The practice was aware of the negative feedback and was working towards solutions to increase the number of appointments and having more staff answer the telephones and had recently employed a reception manager to help.
• There were systems in place to mitigate safety risks including analysing significant events and safeguarding. However the management arrangements and records of monitoring systems to improve quality and identify safety risks needed improving.
• The practice had arrangements to respond to emergencies and major incidents.
• Patients’ needs were assessed and care was planned and delivered in line with current legislation.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. However, information about verbal complaints made and actions taken were not recorded. The practice sought patient views about improvements that could be made to the service; including having a patient participation group (PPG) and acted, where possible, on feedback.
• Staff received training relevant to their role but it was unclear if safeguarding training was completed to the expected level of competence. In addition, staff had not received training in the Mental Capacity Act. Staff did receive regular appraisals.
• Many of the staff had worked at the practice for a long time and knew the patients well. Staff worked well together as a team and all felt supported to carry out their roles.

The areas where the provider must make improvements are:

• Ensure risk assessments required by health and safety legislation are completed; and improve on quality assurance and monitoring systems and related records. 
• The practice must record and monitor verbal complaints.

The areas where the provider should make improvement are:

• Ensure all staff receive safeguarding training and Mental Capacity Act training appropriate for their role.
• Continue to monitor patient satisfaction with regards to appointment and telephone access and respond when necessary.
• Continue to monitor patient satisfaction with regards to appointment and telephone access and respond when necessary.
• Ensure emergency medications are appropriately stored.
• Encourage staff to report both positive and negative incidents.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice