Brigstock Medical Centre Also known as Brigstock and South Norwood Partnership

Brigstock Medical Centre is a provider registered with CQC.

We carried out an inspection of the provider on 28 May 2019 to follow up concerns identified on our previous inspection which was carried out in April 2018 where the practice was rated requires improvement overall and we identified breaches of regulation 12 (safe care and treatment) and regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At that inspection we identified the following concerns:

• DBS checks had not been undertaken for clinical staff.
• There was no system of checks on the defibrillator.
• The fire alarms were not being checked to see if there were working with sufficient regularity.
• References had not been taken in line with the practice’s recruitment policy.
• The results of the 2017 National GP Patient Survey had not been considered.
• There was no effective system to assess of the risk of, and prevent, detect and control the spread of, infections, including those that are health care associated.
• One clinical staff member had not completed adult safeguarding training.
• Not all staff had received suitable training in basic life support.
• Some policies were not in line with guidance or contractual obligations.

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.

Following this inspection we have rated this practice as good overall and good for all population groups with the exception of families children and young people which was rated as requires improvement.

We rated the practice as requires improvement for providing safe services because:

• Not all staff working at the service had a DBS check completed at the point of recruitment. The practice had either not undertaken checks or relied on checks undertaken by other healthcare services that were two to three years old. One clinical staff member did not have a record of their immunity to common communicable diseases on file. After our inspection the provider supplied evidence of staff immunity and evidence that they had risk assessed the need for a DBS for one staff member and had submitted a DBS application for them. We were also supplied with evidence after our inspection which suggested that the provider had undertaken a DBS status check for the other staff members who had out of date DBS checks.
• The practice had systems in place for the safe management of patients’ medicines including high risk medicines.
• Risk management systems were in place. There were systems for testing the practice water supply for legionella although a risk assessment had not been completed. No cleaning schedules had been completed by the practice’s contract cleaners.
• Safeguarding systems and processes were clear and effective.
• Staff were all aware of the systems and process for reporting significant events and we saw good examples of learning and action taken to prevent reoccurrence.

We rated the practice as good for providing effective services because:

• There was evidence of quality improvement activity.
• Staff were receiving regular appraisals.
• Effective joint working was in place. The practice held integrated care meetings with other heatlh and social care organisations that aimed to provide a holistic package of care for those with complex needs.
• Patients were receiving regular reviews and the treatment provided was in line with current guidelines this was reflected in high levels of achievement against most local and national targets; although performance against targets for childhood immunisations were below the World Health Organisation Targets.

We rated the practice as good for providing caring services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.

We rated the practice as good for responsive services because:

• Complaints were managed in a timely fashion and detailed responses were provided; although some complaints we reviewed did not contain contact information for external organisations patients could escalate their complaint to if they were dissatisfied with the practices’ response.
• Most of the feedback from both the national GP patient survey and comment cards received by CQC indicated that it was easy to access care and treatment at the practice. The practice had taken steps to improve access in response to feedback from patients.

We rated the practice as good for providing well-led services because:

• There were effective governance arrangements in most areas.
• The provider had adequate systems in place to assess, monitor and address most risks.
• The provider did not have an active patient participation group but had obtained feedback through group consultation sessions and their own internal patient survey.
• There was evidence of continuous improvement or innovation.
• Staff provided positive feedback about working at the practice which indicated that there was a good working culture.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.

The areas where the provider should make improvements are:

• Review areas of high QOF exception reporting and low QOF scoring to improve performance and ensure that exception reporting is appropriate.
• Continue with work to improve the uptake of childhood immunisations and bowel screening.
• Make non clinical staff aware of issues related to child consent.
• Review and improve mechanisms to engage with patients and obtain feedback used to improve the quality and satisfaction with the service provided.
• Improve systems to record minutes of meetings.
• Consider alternative premises as part of the practice’s business continuity arrangements and include contact information for all staff.
• Review the arrangements in place to assess and address risks associated with legionella and to monitor the work undertaken by contract cleaning staff.
• Include information for organisations that the patients can escalate complaints to in complaint responses.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and the evidence tables for further information.