Archived: Northcote Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northcote Medical on 8 November 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. However, we found that some incidents that should have been recorded as significant events were not recorded as such and therefore not followed up effectively.
• Some risks to patients were assessed and managed, with the exception of: staff carrying out the role of chaperone without DBS checks. Also the practice did not have systems to ensure emergency equipment was checked on a regular basis; and infection control practices were not being followed.

• The practices exception reporting rate was 18% which was higher than the CCG average of 7%. The practice were not aware of the reasons for this.

• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.

• Information about services was limited and not everybody would be able to understand or access it. For example, there were no information leaflets available in Punjabi or Gujarati despite there being a large number of patients from that patient population group on the practice list.

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

• Patients we spoke with on the day of the inspection said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

• The practice did not have information on display that informed patients about language interpretation services available.

• The practice had a number of policies and procedures to govern activity, but these were not always followed.

• Though the practice had a leadership structure, there was insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

• Record and investigate safety incidents thoroughly and ensure that patients affected receive reasonable support and a verbal and written apology.

• Ensure all staff undertaking the role of chaperone have the required training and a risk assessment with regard to needing a DBS check or a DBS check.

• Address concerns found with infection prevention and control.Patient Group Directives (PGDs) must be available at the premises at all times.
• Improve prescriptions pads storage and monitoring to ensure patient safety.

• Carry out regular checks on emergency equipment to ensure it is in good working order.

• Ensure they follow their systems and proceses to ensure that risk assessments are carried out to ensure fit and proper persons are employed.

• Ensure they develop a system that obtains patients views on improving the service and review areas where the practice have scored below average from the national GP survey results published in July 2016.

• Undertake a programme of quality improvement activity including clinical audits and re-audits to improve patient outcomes.
• Ensure staff meetings are held on a regular basis and the system of recording these minutes is effective.
• Ensure they develop a system for staff appraisal and development.

In addition the provider should:

• Modify the practices policies to support the recording of notifiable incidents under the duty of candour.

• Update the business continuity plan so it includes all staff contact details.

• Maintain arrangements that ensure patients dignity is maintained during examinations.
• Improve the process of identifying carers to ensure they receive support and information as appropriate.

• Provide practice information in appropriate languages and formats.

I am placing this service in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate 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 varying the terms of their registration within six months if they do not improve.

The service 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 service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice