Gladstone Medical Centre - M Salahuddin Also known as Gladstone Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gladstone Medical Centre on 11 February 2016. The overall rating for the practice was inadequate with ratings of inadequate for providing safe, effective, caring and well led services and requires improvement for providing responsive services and the practice was placed in special measures for a period of six months. The full comprehensive report on the Month Year inspection can be found by selecting the ‘all reports’ link for Gladstone Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 3 November 2016. Overall the practice is now rated as good and rated as good for providing safe, effective, responsive and well led services but requires improvement in providing caring services.

Our key findings were:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The practice partners were now working together to support and maintain the changes made at the practice.

• Risks to patients were assessed and well managed.

• An improved recruitment process had been implemented since our last inspection and this had been followed when recruiting new staff.

• An improved safeguarding system and process had been implemented since our last inspection and this had resulted in effective monitoring of vulnerable children and adults.

• An improved medicines management system had been implemented since our last inspection and this had resulted in patients receiving effective safe care and treatment.

• Regular clinical meeting took place as part of the practice’s improvement agenda to improve patient outcomes.

• There were systems in place to ensure lessons were learnt from complaints and actions were clearly recorded and monitored.

• The practice had a system in place to ensure safety alerts and best practice guidance was disseminated across the practice team.

• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their treatment. Patients were positive about their interactions with staff.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There were systems in place to ensure test results were followed up as a result of abnormal results.

• The practice had arrangements in place to deal with emergencies and major incidents.

• The national GP patient survey showed the practice performed worse than local and national averages for consultations with GPs and nurses. The last three national patient survey results showed a downward trend with regard to the practice’s performance in relation to patients’ experiences of consultations with GPs and Nurses. However, this data was collected before our first visit in February 2016 and no further data was available at the time of our second inspection. The practice had begun to take steps to investigate the cause of the low satisfaction rates but this had yet to be fully completed.

The areas where the provider must make improvements are:

• Continue to review and address issues raised in the national patient survey to assure themselves that improvements that have already been made are sustained and have had a positive impact.

In addition the provider should:

• Regularly review recent improvements and consider how the practice can ensure the sustainability of these improvements.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gladstone Medical Centre on the 11 February 2016. Overall the practice is rated as inadequate. The practice is rated inadequate for providing safe, effective caring and well led services and requires improvement for providing responsive services.

Our key findings were as follows:

• There was a lack of systems in place to safeguard children and vulnerable adults from abuse.
• Recruitment systems did not protect patients from receiving inappropriate care and treatment.
• There was a lack of overview of the infection control systems at the practice.
• The practice did not have a system in place to securely store and audit the use of prescription pads. Non-clinical staff were adding medication changes to patient records following receipt of hospital letters. There was no evidence that clinicians had reviewed and assessed the medication changes and were responsible for the reauthorisation process.
• There were no systems in place to share learning from significant events to promote service improvement and safety.
• Regular clinical and team meetings did not take place as part of an improvement agenda to improve patients’ outcomes.
• The practice did not have a system in place that monitored best practice guidelines and guidelines were not followed through risk assessments, audits and random sample checks of patient records.
• There was no system in place to ensure lessons were learnt from complaints and that action was taken including an open and transparent response to patients.
• The national GP patient survey showed the practice performed worse than local and national averages for consultations with GPs and nurses. The last two national patient survey results show a downward trend with regard to the practice’s performance in relation to patients experiences with consultations with GPs and Nurses.
• There were systems in place to ensure results were received for all samples sent for the cervical screening programme and the practice followed up women who were referred as a result of abnormal results.
• The practice had arrangements in place to deal with emergencies and major incidents
• Patients were positive about their interactions with both clinical and non-clinical staff and said they were treated with compassion and dignity.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Develop appropriate procedures for recording, acting on and monitoring significant events, incidents and near misses. Ensure that all incidents are fully investigated and any learning from these is applied and shared with all staff.

• The practice must ensure that learning from complaints is shared with staff and any changes to working practices as a result of learning are implemented.

• Take action to ensure necessary employment checks are in place for all staff and the required information in respect of workers is held securely and can be produced when required. All policies in relation to recruitment must be updated to reflect current legislation.

• Develop appropriate procedures for the safe management of medications and storage of prescriptions.

• Ensure suitable arrangements are in place to safeguard vulnerable adults and children from abuse.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision. Including the implementation of regular clinical and non-clinical meetings, the use of clinical and non- clinical audits and patient survey results to drive improvement in the practice.

On the basis of the ratings given to this practice at this inspection, I am placing the service into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice