St Mark's Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Hedley and Partners (St Marks Medical Centre) on 14 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing effective, caring and responsive and well led services. It was also good for providing services to meet the needs of all population groups of patients. It required improvement for providing safe services.

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. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks, infection control monitoring and building maintenance.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff training was not monitored effectively and there was no system in place to identify when training needed to be updated.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

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

Importantly, the provider must:

• Take action to ensure its recruitment policy, procedures and arrangements are consistently applied to ensure necessary employment checks are in place for all staff and the required information in respect of workers is held.
• Take action to put in place monitoring and audit systems to ensure infection control practices are safe and effective. To minimise the risk of cross contamination and spread of infection including those that are health care associated.

The provider should:

• Take action to monitor the work load of the administration staff to ensure tasks such as non-urgent referrals to secondary care are sent in a timely manner.
• Take action to ensure that staff training needs and completed training are clearly recorded on a system that indicates the dates training is to be provided or is due.
• Take action to ensure reception and administration receive an update to their safeguarding training.
• Take action to ensure the practice management team receive an annual appraisal to support the practice to continue to develop and improve services for patients.

Professor Steve Field CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice