Archived: Balaam Street Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Balaam Street Practice on the 2 June 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe and well led services. It also required improvement for providing services for older people, people with long term-conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia). It was good for providing effective, caring and responsive 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 the availability of emergency oxygen and staff recruitment.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• 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 there was continuity of care, with urgent appointments available the same day.
• The practice did not hold regular governance meetings and issues were discussed at ad hoc meetings.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by management.

• The practice had not proactively sought feedback from patients through its PPG.

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

Importantly the provider must:

• Ensure all clinical and non-clinical staff receives appropriate training in infection control and annual infection control audits are completed.
• Ensure all staff receives basic life support training and the practice explores ways of providing access to oxygen. The National Resuscitation Council has the view that: ‘Current resuscitation guidelines emphasise the use of oxygen, and this should be available whenever possible.’ Oxygen is considered essential in dealing with certain medical emergencies (such as acute exacerbation of asthma and other causes of hypoxaemia, which is an abnormal low level of oxygen in the blood.
• Ensure that recruitment checks have been completed for staff before the start of their employment.
• Ensure the views of patients through its PPG (A PPG is a group of patients registered with a practice who work with the practice to improve services and the quality of care) and of stakeholders about their experiences, quality of care and treatment delivered by the service are sought.

In addition the provider should:

• To exploring ways of increasing QOF performance.
• To provide equality and diversity training to its staff team.
• To hold regular staff meetings, multi-disciplinary meetings and quarterly palliative care meetings. To keep a recorded audit trail of meetings and ensure that governance issues, performance, quality and risks have been discussed.
• To provide locum GPs with a locum induction pack.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice