Archived: The Stroudley Walk Health Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stroudley Walk Health Centre on 10 October 2017. Overall the practice is rated as good.

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

• Staff were aware of current evidence based guidance.
• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• There were good staff recruitment processes although not all staff had a documented induction or had received an appraisal.
• Results from the most recent national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment in relation to nurses but there was a negative variation for GP consultations.
• The practice had clearly defined and embedded systems to minimise risks to patient safety although we found two patients on high risk drugs (for example warfarin and lithium) that had a longer than recommended gap between monitoring. Patient Group Directions (PGDs) used by the nurse needed to be updated.
• The practice had arrangements in place to manage medical emergencies but we found that although checks were made and recorded against emergency equipment, the adult defibrillator pads had passed their expiry date and no child pads were available. There were no emergency drugs carried in the doctors emergency bag but no risk assessment had been carried out to identify whether this was appropriate.
• Information about services and how to complain was available although details of the local NHS complaint advocacy organisation, NHS England and the Ombudsman were not consistently included in responses. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 and the option to use a new online service (WebGP), to communicate with a GP.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events although the threshold for reporting an incident was high and included only poor practice.
• The practice premises were clean, maintained and equipped to treat patients and meet their needs. There were plans in place for new practice premises in 2018.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice had a quality improvement programme although most audits were one cycle.
• We found that the vaccine fridge temperature was monitored but occasionally this went above the maximum recommended limit but with no explanation or check for how long this lasted.

The areas where the provider should make improvement are:

• Review the threshold for significant event reporting in line with best practice guidance.

• Review the monitoring of patients on high risk drugs and availability of emergency equipment and medicines. Update the relevant PGDs.

• Review the results of the GP Patient Survey for GP consultations and consider if further improvement can be made to outcomes in those areas.

• Review the monitoring and recording of the vaccine fridge temperature to ensure products are stored in line with the manufacturer’s guidance at all times.

• Review complaint responses to ensure details of local NHS complaints advocacy, NHS England and the Ombudsman are always referenced.

• Review the staff appraisal system so that all staff whether or not part time have the opportunity for annual appraisal.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice