Talke Clinic

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Talke Clinic on 27 June 2017. Overall the practice is rated as good.

Talke Clinic was formally registered with the Care Quality Commission as a single handed GP practice as Dr Paul Unyolo. We carried out a comprehensive inspection of Dr Paul Unyolo on 9 February 2015 and rated the practice as requires improvement overall with requires improvement for providing safe and effective services and inadequate for well led. A follow up comprehensive inspection was carried out on 30 September 2015 and the practice was rated inadequate overall with inadequate for providing safe and well led services and requires improvement for providing effective and responsive services. The practice was placed into special measures following this inspection. We carried out a third follow up comprehensive inspection on 18 May 2016 and rated the practice requires improvement overall and for providing safe and effective services and inadequate for well led. The practice remained in special measures. Since our inspection on 18 May 2016 a change of provider has taken place at the practice. The full comprehensive reports for 9 February 2015, 30 September 2015 and 18 May 2016 inspections can be found by selecting the ‘all reports’ link for Dr Paul Unyolo on our website at www.cqc.org.uk.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• The practice had clearly defined and embedded systems to minimise risks to patient safety. However, an on-going system to act on the MHRA alert for two medicines used in the treatment of heart failure was not in place.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Staff understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role. However, the practice’s policy for safeguarding vulnerable adults did not reflect the most up to date guidance.
• The advanced nurse practitioner (ANP) was an independent prescriber however, there was no formal system in place to support the ANP in this extended role.
• Processes for handling repeat prescriptions were not effective. Patients had been issued repeat prescriptions beyond the authorised duration.

• There were systems in place to review most high risk medicines. However, for one high risk medicine blood test results had not always been reviewed before a repeat prescription was issued.

• The practice’s recruitment policy did not detail all the legally required recruitment information for employing staff.
• The system to monitor that all patient test results were reviewed by a GP was not effective.
• Results from the national GP patient survey published in July 2016 showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a GP and 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 the management.
• The practice proactively sought feedback from staff and patients, which it acted on. They worked closely with the patient participation group to improve services for patients.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

Ensure care and treatment is provided in a safe way to patients in particular:

• repeat prescriptions.

• high risk medicines.

• an on-going system to act on a recent MHRA alert for two medicines used in the treatment of heart failure.

• a system to check that all important clinical test requests are reviewed and followed up.

The areas where the provider should make improvement are:

• Review and update the practice’s safeguarding vulnerable adult’s policy to reflect the latest guidance.

• Update the recruitment policy to reflect legally required recruitment information.

• Implement a formal system to support the advanced nurse practitioner in their extended role.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice