Archived: The Cambridge Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Southlea Group Practice on 12 January 2017. The overall rating for the practice was good. The practice was rated outstanding for providing responsive services but requires improvement for providing safe services. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Southlea Group Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 8 August 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 12 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good.

Our key findings were as follows:

• Improvements had been made to monitoring infection control. All staff had received training booklets for self-learning and a new infection control lead had been identified.

• Selected members of staff had been booked to attend a two day training course on infection control to support the practice in overseeing processes. The training was booked for October 2017 and March 2018.

• Infection control audits were completed and actions identified. Actions not yet completed had timescales in place.

• The practice had contracted in an external company to oversee monitoring of Legionella risk and regular water temperature testing.

• References were collected and stored as electronic copies in staff personnel files.

• It remained the position that not all practice staff had received the training or training updates they needed in a timely way. The practice had created a training record monitoring system which was reviewed monthly. Gaps had been identified for staff in need of training.

• Not all staff had a record of completed safeguarding training. However clinicians had been booked onto level 3 training for October 2017.

• Not all staff had completed fire safety, information governance or Mental Capacity Act 2005 (MCA) training. However dates had been booked for fire safety awareness and MCA training.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

In addition the provider should:

• Ensure specified information is available regarding each person employed.

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 Southlea Group Practice on 12 January 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed however; these were not always fully implemented and embedded. For example, in relation to infection control.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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 and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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 provider was aware of and complied with the requirements of the duty of candour.
• The practice demonstrated a culture of communitarianism to ensure equality for patients when accessing health care. For example, with the Nepalese community and identified cohorts of vulnerable patients.
• The practice was proactive in developing strategies to deliver health promotion to patients outside of the practice setting. For example, health promotion events at the local shopping centre and health education advice to children.
• The practice was proactive in identifying opportunities to improve services and achieving funding to pursue this. For example, the Discharge to Access initiative and the delivery of minor surgery to all patients within the local area.

We saw two areas of outstanding practice:

• An audit of Nepalese patients with diabetes found that these patients had significantly less well controlled diabetes than non-Nepalese patients. The practice trained the health care assistant, who spoke Nepalese, to discuss diabetes management with patients. A nationally recognised diabetes education programme for ongoing and newly diagnosed diabetes was delivered in Nepalese and took into consideration cultural differences, for example, dietary preferences. Communicating with the communities elders had resulted in a good uptake of the programme by this cohort of patients. A follow up audit two years later demonstrated that there was an overall reduction in inequalities. Differences in mean average blood sugar readings had significantly reduced. There was also an increase in the number of Nepalese patients achieving the level of control recommended by NICE guidelines.

• The practice ensured services were tailored to meet the needs of individuals and delivered in a way that ensured flexibility according to patient needs. The practice initiated a community project, called We Care; which linked health care workers and encouraged effective joint working to support patients identified as vulnerable within their practice population. The identified cohorts were, Nepalese individuals aged over 65 who were considered functionally illiterate, individuals with five or more co-morbidities, individuals aged 75 or more living alone, adults with learning disability, living unsupported in the community, adults with mental health problems living alone and individuals identified by members of the multi-disciplinary team as being vulnerable. A needs assessment was undertaken and problems were identified for 150patients who werewere then signposted to appropriate services for help. As part of this project the practice worked closely with the Nepalese community to develop a DVD, to help overcome the problems of illiteracy which contained health education on chronic disease, male health, female health, drugs and alcohol.

The areas where the provider must make improvements are:

• Ensure essential training is undertaken by all staff in relation to infection control, safeguarding, fire safety, information governance.
• Ensure systems and processes are identified, implemented and reviewed for the management of infection control, including a legionella risk assessment.
• Ensure pre- employment references have been obtained for all staff.

The area where the provide should make improvements are:

• All staff should receive mental capacity training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice