The Southall Medical Centre

Updated 29 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 20 January 2015 at The Southall Medical Centre. At that inspection the practice was rated good overall, but as requires improvement for some aspects of providing safe services. The full comprehensive report on the 20 January 2015 inspection can be found by selecting the ‘all reports’ link for The Southall Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 3 November 2016 to check that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 20 January 2015. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good. Following the desk-top review we found the practice to be good for providing safe services.

Our key findings were as follows:

• Patients with long-term conditions were reviewed by practice nurses under the supervision of doctors and within clinical protocol. 
• An automated external defibrillator (AED) (used to attempt to restart a person’s heart in an emergency) was available and maintained as part of the  emergency equipment schedule.
• A comprehensive locum doctor information pack was available which supported safe and effective care.
• There was a process in place to ensure patient safety alerts had been acted upon.
• All staff had received safeguarding children training to a level relevant to their role.
• Medicines requiring refrigeration were stored in line with guidance.
• The practice continued to monitor access to the practice by telephone through surveys and patient feedback which had resulted in increasing the number of staff answering the telephone at peak times and initiating patient queuing to the telephony system. However, the current national GP patient survey showed only 29% of patients found it easy to get through on the telephone which was lower than the local average of 67% and the national average of 73%.

The areas where the provider should make improvement are:

• Continue to monitor telephone access to the practice.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 4 June 2015

The practice is rated as requires improvement for the care of people with long-term conditions.

The practice provided specific clinics for patients with diabetes, asthma, hypertension and chronic obstructive pulmonary disease (COPD). The practice coordinated diabetes care with community and specialist services for example, a community foot clinic. We spoke with two patients with long-term conditions who felt their condition was monitored effectively and their health had benefited as a result of the care they received from their GP and the practice nurse.

Patients with a range of long-term conditions were offered annual reviews to check that their health and medication needs were being met and in line with current guidance. There was a recall system in place to provide preventative and continuing care for patients. For those people with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

However, we found that the health care assistant given responsibility for signing off annual patient reviews, for example for patients with diabetes. This did not allow for sufficient oversight from a qualified medical professional.

Updated 4 June 2015

The practice is rated as good for the care of families, children and young people. We spoke with a number of parents on the day of the visit. They told us they were very happy with the care their children had received. Parents told us that in their experience, the doctors communicated well with younger children and were able to put them at ease.

There were systems in place to identify and follow-up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances or who repeatedly did not attend for appointments.

Staff were trained in child protection and were aware of the procedures to follow if they were concerned about a child’s wellbeing. Multidisciplinary team meetings were held with GPs, health visitors, social workers and children’s centre staff to discuss and monitor vulnerable children under the age of five. The practice provided a range of services for families, babies, children and young people including child development checks and immunisations.

The practice used a messaging service which reminded parents when their child’s immunisations were due and follow-up telephone calls were made if appointments had not been made. Practice appointments were available outside of school hours and the premises were suitable for children and babies, for example baby-changing facilities were available.

Updated 4 June 2015

The practice is rated as good for the care of older people. Patients over the age of 75 years of age were provided with a named GP and care plans were developed for these patients. Care and treatment was planned with regular reviews to meet the needs of frailer patients.

There were risk assessment processes in place to identify patients at risk of unplanned hospital admission. These patients were reviewed on a regular basis and care plans developed for them. Home visits were provided for patients who were housebound.

The practice did not have any patients receiving palliative care at the time of the inspection. The staff had processes in place to work with other specialists to provide effective end-of-life care based on the “Gold Standards Framework” approach.

Updated 4 June 2015

The practice is rated as good for the population group of working age people. The practice had a higher than average proportion of working age adults on its list.

The practice operated limited extended hours with the healthcare assistant available on Saturday mornings for health checks, reviews and advice. The practice was not open outside 8:00am to 6:30pm during the week. However 82% of respondents to the National GP Patient Survey reported their last appointment was convenient.

Telephone consultations were available on request during opening hours and the practice was in the process of introducing online appointment booking. The practice had also introduced a messaging service which automatically sent text message reminders to patients. One patient we spoke with had signed up to this service and said they found it useful.

The practice offered health checks for new patients and patients aged 40-74. The practice had completed over sixty health checks in the previous three months.

Updated 4 June 2015

The practice is rated as good for the care of people experiencing poor mental health. Practice recall systems were in place for mental health reviews and physical health checks for patients with enduring mental health problems. The practice worked with other health and social care professionals to ensure a multi-disciplinary approach for care management of people experiencing poor mental health.

The practice was signed up to the dementia direct enhanced service (DES) to provide an annual health check for people with dementia. The practice developed care plans for this group and patients were provided with a named GP.

Staff had received training in dementia care, the Mental Capacity Act 2005 and undertaking capacity assessments. We saw evidence that doctors had assessed patients’ capacity to make specific decisions when there was uncertainty about their mental capacity.

Updated 4 June 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice had a register of patients with learning disabilities and offered annual health checks and longer appointments to this group. Almost all patients on the register had had a health check in the previous 12 months.

An interpreter service was available for patients whose first language was not English. The practice website provided information to explain the role of UK health services, the National Health Service (NHS) and the role of GPs for asylum seekers in 20 languages. The practice did not have any homeless patients on its list but we were consistently told by staff that homeless patients would be able to register.

Staff knew how to recognise signs of abuse in vulnerable adults and children. One of the GPs was the assigned lead for safeguarding and child protection. Staff were aware of their responsibilities to share information, report safeguarding concerns and knew how to contact relevant agencies in normal working hours and out-of-hours. The practice had identified domestic violence and female genital mutilation as relevant issues and staff had attended training on recognising warning signs and what to do if they had concerns.