Archived: East Park Medical Centre

This practice is rated as Good overall. (The previous inspection in April 2017 rated the practice as Requires Improvement.)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We had previously inspected this practice on 4 April 2017. At that time we found the practice to be rated as Requires Improvement for providing safe, effective, caring, responsive and well-led care. As part of our inspection process, we also look at the quality of care for specific population groups. The issues identified as requiring improvement affected all the population groups.

We subsequently carried out an announced comprehensive inspection at East Park Medical Centre on 8 December 2017. This was to check whether the practice had addressed and actioned the areas of concern which were raised at the 4 April 2017 inspection.

At this inspection we found:

• All practice policies and procedures were embedded and easily accessible. Any updates were cascaded to staff and discussed in meetings. However, at the time of inspection, not all staff at the Halton site followed the procedures when handling specimens.
• There were systems and processes in place to manage risk and health and safety. All actions were completed regarding risk assessments such as fire.
• There was an embedded system in place for actioning and cascading drug safety alerts.
• There was evidence of shared learning and actions being taken as a result of reported indicents. The practice used incident report to drive change as appropriate.
• The practice had procured the services of an outside agency to support them in improving their systems to ensure all patients were coded appropriately. This was used to support improvements relating to the quality and outcomes framework (QOF).
• There were systems in place for the recall and review of patients. However, the practice had acknowledged they had experienced difficulty in ensuring all patients had received their reviews in line with timescales.
• The practice had engaged with Healthwatch regarding a patient survey and they had also recently commissioned their own. They were using the results of these surveys to identify areas for improvement, such as patient access.
• Information was available for patients in languages and formats suitable for the practice population.
• There had been noticeable improvements in the leadership and management of the practice.
• There was a strong commitment towards continuous learning and improvement throughout the practice. There was evidence of a cohesive team approach and staff were positive when talking about the changes that had happened in the practice.
• There was a range of clinical and non-clinical meetings which were all minuted.
• There was evidence of effective engagement with the patient participation group and using the group to support improvements in patient satisfaction.
• The Care Quality Commission registration processes had been completed in relation to the registered manager.

The areas where the provider should make improvements are:

• Assure themselves that all reception staff who work at the Halton location follow infection prevention and control procedures and know how to access equipment. For example, keys to the cleaning cupboard and emergency drugs cupboard.
• Review and improve the systems in place so that reviews of patients are completed in accordance with their care and treatment requirements.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at East Park Medical Centre on 10 August 2016. The findings at that inspection lead to an overall rating of inadequate and the practice was placed in special measures for a period of six months. We also issued two warning notices for breaches in regulations relating to the Health and Social Care Act 2008. The full comprehensive report for that inspection can be found by selecting the ‘all reports’ link for East Park Medical Centre on our website at www.cqc.org.uk.

Following the period of special measures, an announced comprehensive inspection was undertaken on 4 April 2017. During that inspection we found that the practice had taken considerable action relating to the breaches in regulation. However, there remained a breach in Regulation 12 relating to the actioning of drug safety alerts. Overall the practice is now rated as requires improvement.

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

• The practice had significantly improved their systems and processes. Policies and procedures had been reviewed and were now easily accessible to all staff via the practice computer system.
• Processes had been introduced regarding risk management, which included fire, infection prevention and control, legionella and the security of the reception desk at the Halton Medical Practice location.
• Staff were aware of the importance of incident reporting. All clinical and non-clinical incidents were now reported and recorded as significant events.
• There was a repeat prescribing policy and system now in place for the recall and review of patients; particularly those who were on medicines which required close monitoring.
• A risk assessment had been undertaken regarding the range of medicines available in GPs bags. It had been decided that none would be kept in the bags, however, the practice had introduced a ‘grab bag’ of medicines GPs could use to take on home visits.
• A comprehensive system had been introduced regarding the security of prescriptions; this included the removal of prescriptions from clinical rooms by staff and stored in locked cabinets overnight
• Since the previous inspection the practice had commenced a programme of clinical audit. We saw evidence where completed audits could demonstrate quality improvement regarding patients’ care and treatment.
• We saw evidence that staff were now up to date with their annual appraisals and mandatory training, including fire and safeguarding at the level appropriate for their individual roles. A revised induction and mentoring process had also been implemented for newly recruited staff. Management of clinical staffing had been strengthened; staff said they were “proud to work for the practice”.
• The practice had reinstated the patient participation group and were effectively engaging with the group, particularly in relation to improving the patient experience.
• The GP partners had invested in a complete refurbishment of the premises; patients and staff commented very positively about the changes.
• Although the practice had introduced a process to monitor safety alerts and identify what actions had been undertaken, it was found that not all drug safety alerts had been actioned between December 2016 and February 2017.

The area where the provider must make an improvement is:

• The provider must assess the risks to the health and safety of patients and do all that is reasonably practicable to mitigate any such risks. They must ensure that all drug safety alerts are acted on accordingly, to minimise any risk to patient safety.

The areas where the provider should make improvements are:

• Complete all remaining actions in relation to the fire risk assessment.
• Undertake any outstanding reviews of care and update care plans for all appropriate patients. For example, those with a long term condition, a complex mental health need or those at risk of an unplanned hospital admission.
• Provide practice and health information in appropriate languages and formats which reflect the patient population.
• Take steps to improve patient access to appointments.
• Complete the CQC registration process in relation to a registered manager.

I am taking this service out of special measures. Although we recognise the significant improvements made to the quality of care provided by the service, the service would further benefit from continued support.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice