Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at The Gables Medicentre on 19 October 2016. As a result of our inspection the practice was rated as good overall but required improvement for providing safe services. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for The Gables Medicentre on our website at www.cqc.org.uk.
This inspection was a follow up focused inspection carried out on 5 July 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 19 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Overall the practice is now rated as good.
Our key findings were as follows:
- The arrangements to ensure that risks to patients and staff were assessed and well managed met nationally recognised guidelines. For example, a defibrillator had been installed following the last inspection.
- The monitoring of patients taking high risk medicines had been strengthened.
- A log of risks identified was maintained, which included Visual Display Unit screening.
- Risk assessments included Legionella. We were told that a fire risk assessment was scheduled to be carried out on 7 July 2017, and we subsequently received a copy of this risk assessment.
- Improvements had been made to the telephone system, so that it was easier for patients to contact the practice by telephone, especially when trying to make an appointment. For example, calls were answered by staff in an office on the first floor, which meant that they were answered more quickly, because staff were not dealing with patients at the reception desk. GPs returned triage calls using their mobile phones instead of the landline, which freed up the telephone lines and patients had been encouraged to use the online system for booking routine appointments (51% of patients had signed up to use this service). Despite these changes, results from the the National GP Patient Survey results published on 7 July 2017 showed that only 48% of respondents found it easy to get through to the surgery by telephone.
- A system had been introduced to check that current evidence based clinical guidance was adopted. We saw that local and national guidance was circulated to all clinical staff and discussed at weekly clinical meetings. We viewed several examples, including the new pre-diabetes guidelines, which had prompted the practice to arrange a meeting with a consultant to discuss best practice.
- The management of waste had improved.
- A system had been introduced to monitor the use of prescriptions in the practice.
- The pilot project intended to improve the care of patients diagnosed with dementia had improved identification and treatment of patients with dementia at the practice. Unpublished results from the Quality and Outcomes Framework 2016/17 showed that the number of dementia patients whose care plans had been reviewed in the last 12 months had increased from 56% in 2015/16 to 70% in 2016/17. One of the GPs had received specific training in dementia and could prescribe appropriate medicine. This meant that patients could be seen at an extended one hour appointment in-house instead of having to attend a memory clinic at the local hospital.
- More information for patients had been uploaded to the practice website, including details of the complaints system. A new practice website was in the development phase at the time of our July inspection and was due to go live in August 2017. The draft website was viewed.
However, there was also an area of practice where the provider should make improvements:
- Continue to monitor the telephone access for patients, so that patient experience improves in relation to the ease of getting through to the surgery by telephone.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice