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Archived: Sai Medical Centre Good

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Reports


Inspection carried out on 11 October 2016

During a routine inspection

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 carried out on 14 January 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Sai Medical Centre on 14 January 2016. Overall the practice is rated as inadequate.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. An investigation and analysis were undertaken but not shared with staff in a timely manner. This included where complaints had been made to the practice.
  • Risks to staff and patients were not robustly assessed.
  • Recruitment documentation was being inconsistently sought prior to being employed at the practice.
  • Written induction programmes were not being undertaken. Staff working at the practice felt supported. All staff were receiving appraisals.
  • All staff had been trained in safeguarding procedures and a lead had been identified for both vulnerable adults and children.
  • The practice were not recording the monitoring of emergency medicines to ensure they did not expire.
  • Data showed some patient outcomes were low compared to the locality and nationally. Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
  • Data available to us from the National GP Patient Surveys of July 2015 and January 2016 reflected that patients were not satisfied with the services provided.
  • Urgent appointments were usually available on the day they were requested and also available on Saturdays and Sundays.
  • The practice had a number of policies and procedures to govern activity, and these were readily available for staff to read.
  • The practice had proactively sought feedback from the patient participation group but not in relation to survey data. The practice had not routinely sought feedback from patients.
  • Leaders at the practice displayed openness and encouraged improvement ideas from staff but were not sharing issues affecting the practice with their staff or recording that this had been undertaken.
  • The partners at the practice were not aware of some of the issues affecting the practice and needed to be more involved in the performance of the practice and provide more visible leadership.

The areas where the provider must make improvements are:

  • Ensure recruitment arrangements include all necessary employment checks and documentation for all staff. Ensure that new staff to the practice receive an induction that is recorded and they are signed off as competent for the role.
  • Maximise the use of the patent computerised computer system. Ensure appropriate members of staff are trained to accurately code patients’ diagnoses and record all care and treatment given.
  • Carry out clinical and non-clinical audits to identify areas for improvement in patient outcomes. Ensure an audit trail is in place to reflect that improvement action has been taken and maintained.
  • Undertake a Control of Substances Hazardous to Health risk assessment in relation to substances in use in the workplace.
  • Seek feedback from patients in relation to the services provided at the practice and implement improvements where identified.
  • Ensure that all complaints made receive a timely acknowledgement, are investigated appropriately, updates provided to complainants where appropriate and that the analysis of complaints includes the opportunity for staff to provide feedback and improvement ideas about the issues raised. Ensure serious complaints are treated as significant events where required.
  • Ensure that there is an audit trail for action taken as a result of the learning identified from the analysis of significant events and complaints and that learning is cascaded to all relevant staff.
  • Ensure that the system used for checking that emergency medicines do not expire is recorded.
  • Ensure that patient safety updates and medicine alerts are disseminated to all relevant staff, including locums. Implement a system to ensure that patients requiring repeat prescriptions for blood thinning medicines are receiving appropriate and ongoing review.
  • Review the meetings structure to ensure that staff are aware of performance issues affecting the practice and have the opportunity to provide feedback in a timely manner, about the services provided. Ensure that minutes are recorded that reflect the discussion and any actions that follow, including an audit trail for completion.

The areas where the provider should make improvements are;

  • Ensure that the partners at the practice take a more active role in the leadership of the practice so that there is oversight of the issues affecting performance and that appropriate action is taken to improve.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice