Archived: Sai Medical Centre

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