Archived: picton @ whetley medical centre

Letter from the Chief Inspector of General Practice

We carried out an unannounced comprehensive inspection of this practice on 8 April 2016 which was previously managed by a different provider, following a number of concerns that were raised with the Care Quality Commission. The previous provider was Dr Subrata Basu.

We rated the practice as inadequate in all five domains of safe, effective, caring, responsive and well led. The practice was placed into special measures and the registration of the provider at that time was cancelled.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Subrata Basu on our website at www.cqc.org.uk.

A new provider, Picton Medical Centre was awarded a contract to provide regulated activities at the same location from 18 April 2016. The new provider changed the name of the practice to Picton@whetley medical centre.

We undertook an announced comprehensive inspection on 2 February 2017 to check that the practice had responded to the concerns which were identified during the inspection of 8 April 2016. The practice is now rated as good overall.

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

• The practice had sought to continuously improve the quality of healthcare offered to patients since being awarded the contract to provide services from this location. For example, they had identified a significant number of previously undiagnosed long term conditions and had improved the systems for reviewing patients’ medicine needs, therefore improving health outcomes for patients. In addition they had improved patient access by providing online services and making appointments available for those patients who needed them.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed including where previous concerns had been identified. For example, we saw evidence of the appropriate provision and management of emergency medicines and vaccines, the implementation of policies and procedures and the proactive and timely review of repeat medicines.
• Staff assessed patients’ individual needs and delivered care in line with current evidence based guidance. Additional staff had been recruited and trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. They commented positively on the changes to the practice since the new provider had taken over and on the excellent care and support they had received from the new GPs and the practice team.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a GP or a nurse and there was continuity of care, with urgent appointments, telephone triage and consultation available the same day.
• The practice had introduced colour coded signs to orientate patients with visual or language issues around the practice.
• A priority moving forward for the practice was to identify if a patient was also a carer. The practice were proactively asking older people at appointments if they had any caring responsibilities and we saw that written information was available to direct carers to the various avenues of support available to them.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice was able to evidence that they had reviewed infection prevention and control measures and the health and safety of patients and the environment.
• There was proactive management of the practice and a clear leadership structure. Staff felt very supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• The new provider was able to demonstrate an outstanding response to a significant area of concern we had identified at the inspection of the previous provider. At the inspection in April 2016 we saw that clinical decisions were taken at the practice by unqualified staff, which allowed patients to continue to request and receive medication without the review of a clinician. At this inspection under the new provider, we found that a total of 1,065 patients who were registered with the practice and received regular, repeat prescriptions were reviewed by a GP within one month of the new provider being awarded the contract. This had led to urgent referrals being made to secondary care and a total of 3,578 inappropriately prescribed items being stopped. This led to a significant cost saving for the local health economy.
• The practice manager had completed a training programme to issue food bank vouchers to vulnerable individuals and could offer this service to vulnerable patients. We were told that several members of the team also distributed food, sleeping bags and clothing opportunistically to local homeless people on a weekend and encouraged them to register with a GP.

The area where the provider should make improvements are:

• The practice should continue with their plans to identify vulnerable patients and carers and ensure that the service offered continues to meet their needs.

I am taking this service out of special measures. This recognises the considerable improvements the new provider has made to significantly improve the quality of care provided.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice