Letter from the Chief Inspector of General Practice
Our previous announced comprehensive inspection in July 2016 found breaches of regulations relating to the effective delivery of service. The overall rating of the practice was good. Specifically, the practice was rated good for providing safe, caring, responsive and well-led services and require improvement for the provision of effective services.
After the inspection we had received information of concern from a whistle-blower in relation to patients being placed at risk. In response we carried out an unannounced focused inspection on 28 September 2016. We found breaches of regulations relating to the safe, effective and well-led delivery of services. The practice was not rated during the September 2016 focussed inspection.
Both inspection reports (July 2016 and September 2016) can be found by selecting the ‘all reports’ link for Temple Cowley Medical Group on our website at www.cqc.org.uk. Following both inspections, we received action plans which set out what actions the practice would take to achieve compliance.
We carried out an announced comprehensive inspection at Temple Cowley Medical Group on 22 February 2017. We carried out this inspection to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made.
At this inspection, we found the practice had made some improvements. However, there were areas highlighted during the previous inspections where improvements are still required. Overall the practice is rated as requires improvement. Specifically, we found the practice to require improvement for the provision of safe, responsive and well led services. The practice was rated good for providing effective and caring services. Consequently we rated all population groups as requires improvement.
Our key findings across all the areas we inspected were as follows:
- The practice had demonstrated significant improvement in monitoring of document management system, referral management system and record keeping.
- The practice had carried out a comprehensive risk assessment of branch premises to assess suitability of the premises.
- The practice had taken steps to improve the waiting times for patients on the day of their appointment. However, it was too early to assess the positive impact of some changes made. The patients and staff we spoke with informed us that patients still had to wait a long time in the waiting area and patients said they were not satisfied with the poor availability of pre-bookable appointment with GPs.
- Risks to patients were assessed and managed. However, improvements were required in relation to infection control training, infection control measures and the management of blank prescription forms for use in printers which had not been monitored appropriately.
- There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
- Data showed the practice had demonstrated improvements in patient’s outcomes.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
- Data from the national GP patient survey showed patient outcomes were varied in comparison to others in locality and the national average.
- Information about services and how to complain was available and easy to understand.
- There was a clear leadership structure. However, some staff said they would like the communication and interaction to be improved between the leadership and staff.
- The provider was aware of and complied with the requirements of the duty of candour.
The areas where the provider must make improvements are:
- Ensure and improve the management and tracking of blank prescription forms to use in printers, to ensure this is in accordance with national guidance.
- Ensure and improve the appointment booking system and waiting times for patients in relation to their allotted appointment time.
- Ensure all staff has received infection control training relevant to their role.
The areas where the provider should make improvements are:
- Consider completing a disability access audit of the main premises.
- Review and improve the systems in place regarding infection control measures.
- Consider information posters and leaflets are available in multi-languages and continue to encourage the uptake for the bowel screening programme and other services.
- Consider staff feedback to promote effective communication and provide the opportunity to engage in discussions about how to run and develop the practice.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice