We carried out an announced comprehensive inspection at The Consulting Rooms, on 9 January 2017. The overall rating for the practice was good with the practice rated as requires improvement for being safe.
From the inspection on 9 January 2017, the practice was told they must:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
This was because:
- The practice manager was not registered to receive Medicines and Healthcare products Regulatory Agency (MHRA) alerts and did not have a process in place to monitor actions taken.
- The practice did not have a nominated infection control lead nor had any practice led audits taken place in the previous 12 months.
- Checking of emergency medicines was not always effective.
In addition, the practice was told they should:
- Identify clearly to patients the availability of extended hours.
- Ensure staff training records accurately reflected training staff had received.
- Continue to develop the patient participation group (PPG) to ensure engagement with patients.
The full comprehensive report on the inspection carried out in January 2017 can be found by selecting the ‘all reports’ link for The Consulting Rooms on our website at
www.cqc.org.uk
This focused desktop inspection of The Consulting Rooms undertaken on 1 August 2019 was to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements.
We based our judgement of the quality of care at this service on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
We have rated this practice as good overall and good for all population groups.
Our key findings were:
- The practice had a safety alert protocol and procedure with nominated individuals identified for the management of safety alerts. There was a system for recording and acting on safety alerts.
- An infection control policy was in place with designated leads. A practice wide infection control audit was evident with remedial actions taken as appropriate.
- A policy for checking emergency medicines was in place. There was evidence that showed these were regularly checked.
- Details of the availability of extended hours were provided in posters in the patient waiting area, and on the practice website.
- Staff training was through an online provider. The online system allowed the practice to keep accurate records of training needed, undertaken and due.
- There was an active patient participation group.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care