This practice is rated as Good overall. (Previous inspection November 2014 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced inspection at Ash Trees Surgery on 26 April 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. They ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met these needs and promoted equality. This included people who were in vulnerable circumstances or who had complex needs.
• Services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw some areas of outstanding practice:

• A “Listening Service” was established by the practice. This was a free, confidential service facilitated by a volunteer chaplain listener on a weekly basis. Patients we spoke to on the day of inspection spoke highly of the service. In 2017, the service was used by 80 patients, some of whom attended for multiple sessions.
• A counsellor who was specially trained to support patients who were military veterans held a regular clinic at the practice. At the time of inspection the practice held a register of 20 patients who had served in the military.

• The practice had approached the local Citizens Advice Bureau (CAB) to set up a clinic at the practice. Patients could get advice from (CAB) staff about social issues, such as funding for carers. We spoke to patients who used the service, all of whom found it beneficial and told us it had allowed them to access information or funding they would have struggled to otherwise obtain.

The areas where the provider should make improvements are:

• Take steps to ensure the fire alarms at the branch practices are being checked regularly.
• Take measures to ensure the safety of the boiler at the main surgery.
• Investigate the reasons for lower than average results in some areas of the last National GP Patient Survey.
• Document verbal complaints made to the practice so they can be used to look for areas of improvement.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ash Trees Surgery on 14 October 2014. The overall rating for the practice was good, although the practice was rated as requires improvement for safety. The full comprehensive report on the October 2014 inspection can be found by selecting the ‘all reports’ link for Ash Trees Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 September 2017 to assess the improvements that the practice had made following the recommendations laid out at our previous inspection on 14 October 2014. This report covers our findings in relation to those improvements made since our last inspection.

The practice is now rated as good for safe services, and overall the practice is rated as good.

Our key findings were as follows:

• The practice had taken action to address the concerns raised at the CQC inspection in October 2014. Risk assessments and policies had been in place for some time to improve safety in areas such as patient consent, infection control and medicines management.
• There was a central record of staff training, and we saw that staff were undertaking the training required for their role.
• There was a register of patients who were carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected Ash Trees Surgery on 14 October 2014. The inspection was scheduled as part of our new comprehensive inspection programme and was announced to the practice.

The practice operates branch surgeries in Bolton-le-Sands, Silverdale and Halton. These services were not inspected as part of this visit. However, we did leave CQC comment cards at each location and invite patients to provide us with feedback.

A merger between Ash Trees Surgery and a practice in Arnside came into effect on 1 October 2014 but at the time of inspection the practices continued to operate under separate contracts with the Clinical Commissioning Group and maintained separate patient lists. The Arnside practice was not therefore considered as part of this inspection.

The practice is registered with the CQC to the provide the following regulated activities:

• Diagnostic and screening services
• Family planning
• Maternity and midwifery
• Surgical procedures
• Treatment of disease, disorder or injury

Our key findings were as follows:

• The practice was rated as requires improvement for safe
• The practice was rated as good for effective
• The practice was rated as good for caring
• The practice was rated as good for responsive
• The practice was rated as good for well led

We saw several areas of outstanding practice including:

• The systems in place to help patients/carers support emotionally with care and treatment
• The systems in place for working with colleagues and other services in response to bereavement.

The provider should:

• Implement actions to improve aspects of the service identified during inspection and detailed in this report. For example, the systems in place to prevent and control infection, records in relation to staff training, staff knowledge of the requirements of the Mental Capacity Act 2005, a register of carers and policy on patient consent.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patients we spoke with provided positive feedback about the service they received at Ash Tree Surgery. They told us the staff were considerate and helpful. Comments included, “Consistent service, can’t fault it at all”. Another patient told us, “The staff have all the time in the world. I have been coming here for a long time and the service is very good”.

Patients who used the service were given appropriate information and support regarding their care or treatment. One person told us "The doctor has referred me on a number of occasions for different things. He explained everything fully each time so there were no surprises."

Patient’s privacy, dignity and independence were respected. Some comments from people using the service included "They always see you in private and make sure the door is shut”. Time spent in the reception area identified there was potential for people to listen to conversations taking place between reception staff and patients either at the desk or on the telephone. Staff recognised this and tried to take steps to manage it.

There were systems in place to reduce the risk and spread of infection. When we spoke with patients using the service some comments included "Always clean and fresh to me, they seem to keep on top of things”. Procedures were in place, which staff were familiar with. This ensured there were preventative measures for the control of infection.