We carried out an announced comprehensive inspection at Billinge Medical Practice on the 25 May 2016. The overall rating for the practice was good. The rating for the key question of safe was requires improvement. The full comprehensive report for the inspection

of 25 May 2016 can be found by selecting the ‘all reports’ link for Billinge Medical Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 16 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation 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.

After the comprehensive inspection of 25 May 2016 the practice wrote to us to say what they would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Our key findings were as follows:

• The practice had addressed the issues identified during the previous inspection.

• They had provided an up to date electrical certificate for the premises. They have carried out a detailed disability risk assessment.

• They have displayed their complaints procedure which is accessible to patients and also provided a compliment and suggestion box for their patients.

• Opening hours for the practice have been updated and displayed in both premises.

• They have a planned maintenance programme for the premise.

Letter from the Chief Inspector of General Practice

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 Billinge Medical Practice on 25 May 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 reporting and recording significant events.
• Safeguarding processes were in place and followed by staff.
• Risks to patients were assessed and well managed, apart from those relating to the premises. The practice did not have an electrical installation certificate to show safe management of the building.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect.
• Information about services and how to complain was available and complaint records showed good responses to formal complaints. However the policy was kept at reception and some concerns from patients on NHS choices had not been reviewed.
• Patients were happy with improvements at the practice although some patients commented that trying to get through to the practice by phone was difficult and that they found this frustrating.
• Some patients said they found difficulties accessing appointments but the majority were happy with improvements being made. Urgent appointments were available the same day.
• The practice had appropriate facilities and was equipped to treat patients and meet their needs. The branch surgery needed improvements to the environment including the need of a disabled access toilet. The buildings was clean and tidy.
• There was a clear leadership structure and staff felt supported by management. The practice acted positively in response to feedback from patients and staff.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider MUST make improvements are:

• The registered person did not have a robust system for identifying, assessing and managing risks associated with the building. They did not provide evidence of an up to date electrical certificate for the premises to show the building was fit for purpose and safe for patient and staff use.

The areas where the provider should make improvements are:

• They should review access and availability of the complaints procedure.

• A risk assessment should be undertaken to ensure that all reasonable adjustments have been made to the practice for disabled people when accessing services.

• They should update patient information including accessing open hours at the practice and branch surgery.

• The provider should ensure that a detailed planned preventative maintenance and refurbishment plan is put into place which covers both the main practice site and their branch surgery.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patients spoke positively about the practice and the care they received. Comments included; “The staff are absolutely superb, they have looked after my family really well,” and “We have always been very satisfied.”

The practice had an emergency drugs box which the practice nurse told us was checked on a monthly basis. Records confirmed this. Patients we spoke with confirmed they had time to discuss their concerns during the consultation and that treatment options were explained to them.

The practice had up to date ‘child protection’ and ‘safeguarding vulnerable adults’ policies and procedures to support staff to identify signs of abuse and take appropriate actions. This information included contact details for staff to raise concerns with the appropriate agencies.

The manager confirmed that a period of induction was arranged for new staff to support them in the first few weeks of working at the practice. The practice had a ‘locum information pack’. This supported the locum GP keep up to date with any changes, for example in the practice’s referral procedures and prescribing guidelines.

We looked at two significant events that occurred in the last six months and saw the changes made by the practice as a result, for example, to staff training and guidance.