Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Audlem Medical Practice on 15 September 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Safety alerts were received and acted upon.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• Staff had been trained to deal with medical emergencies and emergency medicines and equipment were available.

• Infection control procedures were in place.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear approach to working with others to improve care outcomes with a clear strategy and objectives including engaging with other key partners in providing health services.
• There was a clear leadership structure and staff were well supported by the GP partners.

• Staff were supervised, felt involved and worked as a team.

• The provider was aware of and complied with the requirements of the duty of candour.

There were areas of practice where the provider should make improvements, these were:

• Review how patients and public access consulting rooms to ensure appropriate security of staff and equipment.

• Have sufficient oversight and awareness of levels of exception reporting.

• Review the regularity at which electrical equipment is checked.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke to two of the four doctors working at the practice, the practice manager, the deputy manager, one of the two nurses, three people using the service that day and one of their relatives.

The people we spoke to told us that they felt their dignity and respect was very much maintained by the doctors and other staff. One person told us; “I am always treated with dignity and respect when I am here.”

People told us they were treated well at this practice and they were happy with the service provided. One person we spoke to said; "They are all absolutely fabulous, they are.”

The staff we spoke to were clear on their responsibilities in reporting any suspicions or concerns that they have relating to vulnerable adults and children.

One member of staff told us; “It’s great working here, there is a good team atmosphere and everyone is valued.”

One member of staff told us; “If I can resolve a minor complaint myself, then I will. I would still inform the practice manager about it."

We carried out an announced comprehensive inspection at The Audlem Medical Practice on 19 December 2018 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We rated the practice as requires improvement for providing safe services because:

• The practice had systems to manage risk so that safety incidents were less likely to happen. However, we identified examples of repeated incidents/ significant events that impacted on patient safety.
• The majority of clinical staff did not have safeguarding training appropriate to their role and responsibilities.
• The practice could not demonstrate the clinical reason why some medicines had been prescribed.

We found that:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• The most recent results from the GP national patient survey (August 2018) showed patient satisfaction with the service for making an appointment, appointment times, overall experience and getting through to the practice by telephone were higher than local and national averages.
• The practice organised and delivered services to meet the needs of patients.
• There was a system in place for investigating and responding to patient feedback including complaints.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Ensure that clinical staff have received safeguarding training at a suitable level to their role.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Continue to monitor the level of exception reporting at the practice and review changes made to the recall system to offer assurance that more patients are being reviewed and receiving appropriate treatment.
• The safeguarding policy and procedure should be reviewed and amended to include information and guidance with regard to female genital mutilation (FGM), modern slavery and child sexual exploitation.
• Regular reviews of the new system being put in place to offer a structured and formal monitoring and supervision system for the advanced nurse practitioners (ANPs) and salaried GPs should take place to offer assurance that the treatment being provided is safe and appropriate.
• The system in place to monitor and check that patient group directives (PGDs) were appropriately authorised to enable staff to administer medicines should be reviewed to ensure all have the required authorisation.
• Suitable infection control training should be provided to the designated infection control lead.