Archived: SSAFA Care CIC Health and Walk In Centre Also known as SSAFA Care CIC

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at SSAFA Care CIC Health and Walk In Centre on 21 March 2017. Overall the practice is rated as inadequate.

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. However, reviews and investigations were not thorough enough. Not all members of staff were involved in regular significant event meetings.
• Patients were at risk of harm because systems and processes to keep them safe were ineffective. For example, the processes in place to review and monitor patients prescribed high-risk medicines was inconsistent and reviews were not always completed in accordance with best practice guidance.
• Patient care records in relation to some home visits carried out were not found to be accurate and did not represent the actual care and treatment of patients. Clinical staff were unable to confirm whether some visits had taken place.
• Although some clinical audits had been carried out, not all audits were used to drive improvements to patient outcomes.
• There was a system in place within Leicester, Leicestershire and Rutland CCGs for all urgent care services including some emergency services whereby these providers had access to twice daily calls to discuss and monitor patient demand and capacity. These providers worked together in cases of high demand on services and put emergency plans into place to ensure effective use of these services within LLR.
• There was one key performance indicator in place between the local CCG and the walk in centre which was to ensure 90% of patients to be seen within 30 minutes of arrival. The practice continually achieved this KPI throughout the past 12 months, we saw evidence to show that the achievement for January-March 2017 was 97% compared to October-December 2016 when the practice achieved 98%.
• Results from the national GP patient survey showed patients felt they were treated with compassion, dignity and respect. The practice was above average for its satisfaction scores on consultations with GPs and nurses.
• Information about services and how to complain was available and easy to understand. However, the practice did not have a system in place for all staff including non-clinical staff to learn from complaints through discussion at regular meetings or via direct feedback.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a number of policies and procedures in place to govern activity.

The areas where the provider must make improvements are:

• Review governance and clinical oversight arrangements including systems for assessing and monitoring risks and the quality of the service provision such as implementing a system of effective clinical audits and re-audits to improve patient outcomes.

• Review process in place to ensure the safeguarding register is up to date and accurate and monitored regularly.

• Ensure systems and processes are in place to ensure patients prescribed high-risk medicines are monitored appropriately ensuring all required reviews are carried out.

• Ensure that an accurate, complete and contemporaneous record is maintained for every patient.

• Review processes for reporting, recording, acting on and monitoring significant events, incidents, near misses and complaints. Ensuring actions taken and lessons learned are shared with the wider team and actions are documented with timely review dates.

In addition the provider should:

• Review methods of communication and meeting structures to ensure all practice staff clinical and non-clinical are provided with the opportunity to be involved in discussions about the practice.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice