Archived: Francis Road Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Francis Road Medical Centre on 12 May 2016. Overall the practice is rated as requires improvement.

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

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses and carried out investigations when there were unintended or unexpected safety incidents. However, the practice could not demonstrate how learning was shared with staff.
• Patients were at risk of harm because systems and processes were not implemented in a way to keep them safe. This included recruitment, Disclosure and Barring Service (DBS) checks, mandatory training, infection control, medicine management, dealing with emergencies, premises safety risk assessments.
• The practice had some processes in place to keep patients safe and safeguarded from abuse but none of the non-clinical staff or the practice nurse had undertaken safeguarding children and vulnerable adult training.
• There was a leadership structure and staff felt supported by management. However, governance and leadership arrangements did not support the delivery of good quality care.
• The practice had a number of policies and procedures to govern activity, but some were overdue a review.
• Information about services and how to complain was available and easy to understand but did not include information in line with national guidance.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure premises risk assessments are completed including health and safety, COSHH and Legionella, and electrical portable appliance testing is undertaken in line with guidance.
• Review the management of medicines to ensure Department of Health guidance is followed when storing vaccines and ensure signed Patient Group Directions (PGDs) to allow nurses to administer medicines in line with legislation are available.
• Implement actions identified from the infection control audit and review the cleaning arrangements for the practice.
• Ensure appropriate recruitment checks are undertaken prior to employment and risk assess the need for Disclosure and Barring Service (DBS) checks specifically for staff acting as chaperones.
• Ensure the practice has risk assessed whether it is able to respond to medical emergencies in line with national guidance.
• Develop an ongoing audit programme that demonstrates continuous improvement to patient care.
• Formulate a written strategy or business plan to deliver the practice’s vision.
• Ensure all policies and procedures to govern activity are reviewed and up-to-date.
• Implement a formal induction process for new staff and carry out annual staff appraisals for all staff.
• Ensure all staff undertake mandatory and role-specific training, in particular safeguarding, chaperoning and infection control.

The areas where the provider should make improvement are:

• Ensure there is an effective system to track blank prescriptions through the practice in line with national guidance.
• Review Disability Discrimination Act (DDA) compliance and consider improving communication with patients who have a hearing impairment.
• Ensure patient information on how to complain is in line with national guidance.
• Review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Ensure up-to-date information is available to locum staff to support safe and effective care.
• Ensure information on how patients can access translation services is advertised within the practice.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice