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Archived: Sai Medical Centre Good

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Inspection Summary


Overall summary & rating

Good

Updated 23 January 2017

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Sai Medical Centre on 14 January 2016. The practice was rated as inadequate overall. Specifically they were rated as requires improvement for safe and responsive, and inadequate for effective, caring and well-led. The practice was placed in special measures for a period of six months.

In particular, on 14 January 2016, we found the following areas of concern:

  • Where complaints or significant incidents were raised, an investigation and analysis were undertaken but not shared with staff in a timely manner.
  • Risks to staff and patients were not well assessed including the management of medicines and patient safety alerts.
  • Recruitment documentation was being inconsistently sought prior to being employed at the practice and written induction programmes were not being undertaken.
  • Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
  • The practice had not routinely sought feedback from patients.
  • The partners at the practice were not aware of some of the issues affecting the practice and needed to provide more visible leadership.

As a result of our findings at this inspection we took enforcement action against the provider and issued them with a warning notice for improvement.

Following the inspection on 14 January 2016 the practice sent us an action plan that explained what actions they would take to meet the regulations in relation to the breaches of regulations and the warning notices that we issued.

We carried out a further comprehensive inspection at Sai Medical Centre on 11 October 2016 to check whether the practice had made the required improvements. We found that all of the improvements had been made.

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

  • Staff were aware of their responsibilities regarding safety, and the reporting and recording of significant events. There were policies and procedures in place to support this. Any learning identified was shared with staff.
  • The practice assessed risks to patients and staff and there were systems in place to manage them.
  • Where patients were prescribed medicines requiring monitoring we found that the system in place was effective. There was a system in place for clinical staff to receive, action and disseminate patient and medicine safety alerts.
  • The practice had a defibrillator and oxygen. There was a system in place to check that equipment was in working order and medicines had not expired.
  • There was no risk assessment to assess whether the practice held stock of appropriate medicines on the premises in the event of a medical emergency.
  • A risk assessment for the Control of Substances Hazardous to Health (COSHH) had been completed and details of chemicals used were kept in a folder accessible to staff.
  • We found although no new staff had been employed since our previous inspection, the provider had an effective recruitment procedure in place.
  • The practice business continuity plan enabled staff to take action in the event of a loss of utilities or premises.
  • Staff had received training in their computer system to be able to accurately code patients’ diagnoses and other relevant information.
  • We saw evidence of audits that demonstrated improvements in patient outcomes, and there was a timetabled audit scheduled for the year.
  • Views of patients from comments card and those we spoke with during the inspection were mostly positive. The majority of patients said they were treated with dignity and respect, and they were involved in their care and decisions about their treatment.
  • The practice had discovered that the GP survey was using two sources of data for their practice and with the support of the local CCG was trying to resolve this as it affected their GP survey scores. The PPG had undertaken an independent survey using the questions from the GP survey to gain a more accurate picture and had seen positive results.
  • Complaints were investigated appropriately and in a timely manner and learning was shared with all staff.
  • The practice had implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from CQC, the local Clinical Commissioning group (CCG) and its own staff.
  • The meeting structure had been reviewed so that all staff were aware of the performance of the practice and any issues affecting the patients. Minutes were available for staff to view.
  • There was now a strong management and staff team structure. The practice manager and two partners worked as a team to ensure that the performance of the practice was maintained and improved.
  • Staff told us they felt supported and involved in the development of the practice.
  • The culture of the practice was friendly, open and honest. It was evident that the practice complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Complete a risk assessment of the emergency medicines that need to be kept onsite.
  • Ensure that the fridge thermometer is reset according to manufacturer’s guidance.
  • Ensure that issues identified from infection control audits are clearly documented and actioned in a timely manner.
  • Improve the identification of patients who are carers.
  • Review their exception reporting to ensure it is accurate.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 January 2017

The practice is rated as good for providing safe services.

  • Staff were aware of and could explain their role and responsibilities in reporting and recording of significant events. They told us, and we found evidence to show, that following investigation of any incidents the outcome was shared with appropriate staff to ensure that lessons were learned and action was taken to improve safety in this area in the future.
  • There was no glucagon in the emergency medicines and no risk assessment to assess the risk of not having this available onsite.
  • When things when wrong involving patients, appropriate actions were taken and a full investigation completed, with the person affected, or their designated next of kin, given accurate and honest information as well as a written apology. They were also informed of any actions taken to prevent reoccurrence of the incident.
  • There were clear safeguarding processes in place for adults and children. Staff were aware of their roles and responsibilities with regards to safeguarding and were aware of potential signs of abuse.
  • There were systems in place for the identification and assessment of potential risks to patients, staff and the premises, and plans in place to minimise these. Where potential risks were identified on the day of our inspection these were immediately investigated to determine what action was required.

Effective

Good

Updated 23 January 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed the majority of patient outcomes were comparable or higher than the CCG and national averages. For example, performance for diabetes related indicators was in line with or above the CCG and national average.
  • Staff had received training in their computer system to be able to accurately code patients’ diagnoses and other relevant information in order for outcomes to be correctly reported via QOF.
  • Staff had access to the latest clinical guidelines and best practice guidance and used these to assess and deliver patient care.
  • Clinical staff used a range of measures to ensure they had the skills, knowledge and experience to provide effective care.
  • We found all staff had received an appraisal and had a personal development plan.
  • The practice completed audits which were relevant to the service and demonstrated quality improvement.
  • Staff had opportunities for career progression and ongoing learning.
  • The practice had positive working relationships with other health and social care staff.

Caring

Good

Updated 23 January 2017

The practice is rated as good for providing caring services.

  • Five out of eight patients that we spoke with during the inspection told us that they felt treated with dignity and respect by staff and that staff were good. They felt involved in decisions about their care. These views were backed up by responses on 44 of the 45 comments cards we received.
  • We saw that staff treated patients with dignity, respect and kindness.
  • The practice had identified 43 patients who were carers. They had found that several of their older patients’ carers were registered at other practices.
  • We saw that some information for patients was available in another language, and others could be made available in different languages or formats.
  • The practice had discovered that the National GP Survey used two sources of data for the practice and was being supported by their CCG to resolve this.

Responsive

Good

Updated 23 January 2017

The practice is rated as good for providing responsive services.

  • The practice was aware of the current and potential future needs of its patient population and was consulting with Clinical Commissioning Group and the local council to secure improvements to services where these were identified. For example, they were looking to purchase more land to extend the practice in order to have space to house equipment so that more tests and investigations could be completed onsite.
  • The latest GP survey, published in July 2016, showed the practice was rated higher than the CCG and national average with regards to satisfaction with opening hours and making an appointment generally.
  • Most patients said they found it easy to make an appointment with urgent appointments available the same day.
  • The practice had accessible facilities and was suitable for breast feeding mothers. There were facilities for those with babies and young children.
  • Information on how to complain was clearly displayed in the waiting area and in the practice leaflet. Complaints were responded to appropriately and lessons learned.

Well-led

Good

Updated 23 January 2017

The practice is rated as good for being well-led.

  • There was a clear leadership structure in place.
  • The governance systems in place had been strengthened.
  • The practice had an effective system in place for monitoring and assessing the quality of services provided through quality improvement activities.
  • Staff felt able to raise concerns and also give suggestions for improvements to the running and development of the practice.
  • The practice had policies and procedures in place, which were relevant to the practice, regularly reviewed and updated as required.
  • There were systems in place for notifying about safety incidents and evidence showed that the practice complied with the duty of candour when investigating and reporting on these incidents.
  • The practice sought feedback from staff and patients, which it acted on. There was a newly restarted patient participation group to provide a ‘critical friend’ for the practice, which had representation from several of the population groups.
Checks on specific services

People with long term conditions

Good

Updated 23 January 2017

The practice is rated as good for the care of people with long-term conditions.

  • Both GPs and the practice nurse took the lead in reviews and management of patients with long term conditions. The practice nurse was encouraged to carry out checks on an opportunistic basis to avoid patients having to re-attend another day.
  • The practice performance for diabetes indicators was in line with and for some indicators higher than the CCG and national averages. For example, the number of patients who had received a foot examination and risk classification was higher than the CCG and national average.
  • If patients required a longer appointment due to complex needs or multiple medical conditions this was available. Housebound patients could also request a home visit.

Families, children and young people

Good

Updated 23 January 2017

The practice is rated as good for the care of families, children and young people.

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
  • Immunisation rates were lower or in line with CCG and national averages for most standard childhood immunisations.
  • Due to opening hours appointments were available outside of school hours.
  • The premises were suitable for children and babies.
  • Young people attended the patient participation group meetings to put their viewpoint across.
  • There was a children’s’ sit and wait service if all appointments were booked.

Older people

Good

Updated 23 January 2017

The practice is rated as good for the care of older people.

  • All older patients had a named GP.
  • Those patients unable to come to the practice, for example, due to being housebound, were able to access home visits from the GP.
  • The practice proactively looked at their register of older people to assess which patients would always require a home visit.
  • The practice saw patients opportunistically for checks and vaccinations to avoid the patient having to re-attend another day.
  • Other professionals told us that the practice have positive working relationships with the care homes and community matrons.

Working age people (including those recently retired and students)

Good

Updated 23 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The practice offered extended hours on a Tuesday evening.
  • Prescriptions were sent electronically to the patients preferred chemist.
  • The practice offered a full range of health promotion and screening that reflects the needs for this age group.
  • The percentage of women aged 25-64 who have had a cervical screening test in the past 5 years was lower than the CCG and national average.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 January 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • 82% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG and national average.
  • The practice performance for mental health indicators was lower than the CCG and national average. This was due to the very low numbers of patients affecting the data.
  • For some mental health indicators the practice exception reporting was high compared to the local and national averages (The QOF includes the concept of 'exception reporting' to ensure that practices are not penalised where, for example, patients do not attend for review).
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • There was information in the waiting area to sign post patients experiencing poor mental health to various support groups and voluntary organisations.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • The practice supported patients through the transition from adolescent to adult services.

People whose circumstances may make them vulnerable

Good

Updated 23 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice was aware of those patients on their register who lived in vulnerable circumstances.
  • If patients required a longer appointment due to complex needs or multiple medical conditions this was available.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • There were established systems and processes in place to ensure patient safety and enable staff to identify and take appropriate action to safeguard patients from abuse. Staff knew how to recognise signs of abuse in vulnerable adults and children.
  • The practice had identified 43 patients as carers (0.8% of the practice list).