Letter from the Chief Inspector of General Practice

This practice is rated as requires improvement overall. (Previous inspection 26/05/2015 – Outstanding)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Requires Improvement

Are services responsive? – Requires Improvement

Are services well-led? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires Improvement

People with long-term conditions –Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those retired and students) – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) – Requires Improvement

We carried out an announced comprehensive inspection at Beacon Primary Care on 15 January 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• There were established and comprehensive systems in place to manage and monitor risks to patients, staff and visitors. This included risks to the building, environment, medicines management, staffing, equipment and a range of emergencies that might affect operation of the practice.

• The practice routinely reviewed the quality, effectiveness and appropriateness of the care it provided. Care and treatment were delivered according to evidence-based guidelines.We saw that a wide range of clinical audit was carried out.

• There was a formal system to audit clinical decision making and non-medical prescribing for clinicians working in advanced roles and staff felt well supported.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Staff understood their role in safeguarding vulnerable patients. They were fully aware they should go to the lead GP for safeguarding for further guidance. The GP held monthly meetings with health visitors, school nurses and practice staff. There was a regularly updated spreadsheet of all patients known to be at risk.

• The practice reviewed the needs of their local population and had initiated positive service improvements for patients. They implemented suggestions for improvements as a consequence of feedback from the patient participation group.

• There was evidence that innovation and service improvement was a priority among staff and leaders with evidence of strong team working and commitment to personal and professional development.

• The National GP patient survey results were generally below the CCG and national averages. It was unclear how the practice had responded to this.

We saw five areas of outstanding practice :-

• The practice had completed a wide ranging programme of clinical audits over the last 12 months which had resulted in improved patient outcomes. For example there were 17 care homes in the locality and all were provided with regular telephone advice and support. Weekly ward rounds were undertaken in seven of the homes which covered 161 of 198 patients registered in care homes. The practice pharmacist also visited these homes regularly to review patients’ medications, especially after discharge from hospital. Practice staff had developed an enhanced health framework for patients in care homes including access to telemedicine advice. Audit activity demonstrated that all of these initiatives had reduced the high demand for individual visits.

• The practice had introduced ‘Patient Friends’ who were reception staff who were available throughout the day to review and discuss any problems from the patient’s perspective and use their knowledge of the practice to find a way of resolving issues quickly.

• The practice had taken part in the Routine Enquiry into Adverse Childhood experience (REACH) feasibility project which had been carried out to investigate long term physical and mental health problems in a primary care setting. As a result staff had been trained to identify and offer support where appropriate.

• The practice had developed a Well Pathway for patients with dementia covering prevention, diagnosis, living with and supporting people and dying well, with hypertext links to local and national support organisations.

• The practice was a member of the North West Alliance Primary Care Home which aimed to improve services in communities and offer patients opportunities to maximise their health. They worked together with partner organisations in the voluntary, social care and faith sectors.

The areas where the provider should make improvements are:

• All GPs should monitor the expiry dates of medicines kept in their medical bags.

• Continue to identify and support patients who are also carers

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating March 2018 – Requires Improvement)

The key questions at this inspection are rated as:

Are services caring? – Good

Are services responsive? – Good

We carried out an announced comprehensive inspection at Beacon Primary Care on 15 March 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. At this inspection we rated the practice as requires improvement overall, with requires improvement ratings for the key questions of caring and responsive due to poor patient feedback about their experiences at the service. The full report from our March 2018 inspection can be found here: https://www.cqc.org.uk/location/ 1-543753416.

We carried out a focussed follow up inspection on 25 September 2018 to establish how the practice had addressed the concerns identified at the March 2018 visit. This visit inspected the caring and responsive key questions only. The practice is now rated good for both the caring and responsive key questions and good overall.

At this inspection we found:

• The practice had implemented changes to address patient feedback around experience and access.
• The appointment system had been reviewed and updated to improve its effectiveness.
• Telephone triage appointment slots had been lengthened from five to seven minutes in order to allow for more effective management of the patients’ presenting problems.
• Clinical capacity had been increased.
• The practice had created and recruited to a new non-clinical post to focus on organisational development and communications, with particular focus on patient and public engagement.
• The practice’s telephone system was being updated to incorporate an additional line specifically for managing prescription requests.
• A new system had been implemented to facilitate the proactive identification of patients with caring responsibility, as well as to identify patients with hearing or visual impairment or those who were housebound.
• Following our inspection in March 2018, we recommended the practice should review how it monitored expiry dates of medicines held in the GPs’ bags. At this inspection we saw a new system had been put in place which was operating effectively. All medicines were in date.

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

Please refer to the detailed report and the evidence tables for further information.