Leacroft Medical Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Leacroft Medical Practice on 25 May 2016. During this inspection we found breaches of legal requirement and the provider was rated as requires improvement under the effective and well-led domains. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Leacroft Medical Practice on our website at www.cqc.org.uk. The practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring that all Patient Group Directives are recorded and completed correctly, in line with legislation.

• Improving the pathways for the obtaining and dissemination of relevant and current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines.

• Ensuring that all correspondence relating to patients, including results, are actioned in a timely manner.

• Ensuring a complete urgent referral process is implemented where cancer is suspected, to include confirmation that the referral has been sent and received.

• Formally documenting all practice specific policies and procedures and ensure these are made available to all staff.

• Improving the mechanisms for staff to raise concerns; ensuring consistent support and mentorship is available from all members of the management team.

Additionally;

• Ensuring a complete audit trail for the recording of significant events to include reference of an event to the subsequent discussion at a practice meeting.

• Ensuring that alerts for children and adults at risk, which are placed on the practice computer, are also placed on family members’ records, as appropriate.

• Consider ensuring care plans were generated and available separately to individual patient notes.

• Continue to monitor access to appointments, including the telephone system for patients.

• Formally document and communicate to all staff the practice governance, vision, strategy and supporting business plan.

This inspection was an announced focused inspection carried out on 23 February 2017 to confirm 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 25 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• Patient Group Directives were recorded and completed correctly for all appropriate staff, in line with legislation.

• Evidence was seen to demonstrate that the practice had taken steps to include updates on good practice and national guidance at regular meetings, including National Institute for Health and Care Excellence (NICE) best practice guidelines.

• We found that all correspondence relating to patients, including results, had been actioned in a timely manner.

• A new system to monitor the urgent referral process was implemented where cancer is suspected. This included confirmation that the referral has been sent and received.

• All practice specific policies and procedures were now in place and these were available to all staff.

• The practice had reviewed its approach to systems they had in place to enable staff to raise concerns and the support and mentorship available to staff from the management team. Staff reported that they were fully supported and were able to engage with the current management team to raise concerns or make suggestions as appropriate.

Additionally;

• Since our last inspection the practice has engaged with Crawley CCG taking part in the PACE Setter initiative (the primary care quality mark for children and young adults being rolled out across Surrey and Sussex). The practice has been nominated for an award for their work developing patient action plans in relation to asthma for children and young adults. Results will be announced at the end on March 2017.
• Patient care plans we reviewed were detailed and in line with national guidance.
• Significant events were discussed at regular meetings and a unique identifying number was used to link the record and the meeting.
• Systems were in place to alert staff when a child or adult was at risk and this had been expanded to include family members where appropriate.
• The practice continues to monitor the appointment access for patients. The practice reported that appointments were quickly filled when they were released. We were told appointments were released weekly and the ability to book in advance is limited. The practice is increasing the extended hours appointments during March to address a shortfall in this area. The practice carried out a patient survey in which 60% of respondents said there had been an improvement in appointment availability. The practice is looking to recruit an additional nurse to focus on working with frail and vulnerable patients to assist with access to appointments.
• The practice is currently developing plans for their future and we saw some information on their vision for the service. A formal business plan was not in place as yet.
• The practice is now taking part in the social prescribing initiative. Social prescribing is a way of linking patients in primary care with sources of support within the community. It provides GPs with a non-medical referral option that can operate alongside existing treatments to improve health and well-being.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice