Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Birches Head Medical Centre on 18 January 2016. The overall rating for the practice was Good with requiring improvement in providing safe services. We found one breach of a legal requirement and as a result we issued a requirement notice. The practice provided us with an action plan detailing how they were going to make the required improvements in relation to:

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Safe care and treatment.

You can read the report from our inspection on 18 January 2016 by selecting the 'all reports' link for Birches Head Medical Centre on our website at www.cqc.org.uk.

We undertook a comprehensive follow up inspection of Birches Head Medical Centre on 24 July 2017. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

Our key findings were as follows:

• There was effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Effective systems were now in place for identifying, assessing and mitigating the risks to the health and safety of patients and staff.
• The practice had clearly defined and embedded safeguarding procedures in place. A system was now in place to alert staff to known vulnerable adults.
• The practice system for prescribing high risk medicines on a shared care basis had improved ensuring patients had received the recommended monitoring before prescriptions were issued.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver care and treatment.
• Patients said they were treated with kindness, dignity and respect and they were involved in their care and decisions about their treatment.
• Data from the national GP patient survey published July 2017 showed patient satisfaction continued to be above local Clinical Commissioning Group (CCG) and national averages for most areas measured.
• Patients found it easy to make an appointment, with urgent appointments available the same day and routine appointments available within 48 hours.
• There was a clear leadership structure in place and staff felt supported by the partners and practice management team. Staff were aware of the vision and values for the delivery of services.
• The practice was proactive in gaining feedback from patients and staff and made improvements following suggestions.
• The provider was aware of and complied with the requirements of the Duty of Candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvements are:

• Consider anonymising significant events in addition to completing an analysis of significant events to identify any common trends and embed learning.
• Review the process for the monitoring of uncollected prescriptions.
• Consider expanding the availability of staff to chaperone to provide a more flexible service for patients.
• Consider developing a documented business plan.

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 Birches Head Medical Centre on 18 January 2016. As part of our inspection we visited both the main and branch (Hulton House Surgery) locations. Overall the practice is rated as good, with requires improvement in safe services.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the Care Quality Commission (CQC) at that time.

Our key findings were as follows:

• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was an effective system in place for reporting and recording significant events.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The practice was proactive in getting feedback from patients and made improvements following suggestions.
• Risks to patients were assessed and well managed, with the exception of those relating to infection prevention and control.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Operate an effective system to ensure current infection prevention and control practice is followed.

• Ensure that patients, visitors and staff are protected from the risk of water borne infection by means of completing a legionella risk assessment.

In addition the provider should:

• Implement a consistent system for checking that monitoring for patients, who take long term medicines on a shared care basis, has been provided before the medicines are issued.

• Ensure that all relevant staff have up to date medical indemnity insurance in place.

• Improve storage and handling of blank prescription forms to reflect nationally accepted guidance as detailed in NHS Protect Security of prescription forms guidance.

• Consider a system to alert staff to known vulnerable adults.

• Consider implementing a recorded system of sharing practice wide learning and governance issues with non-clinical staff.

• Consider adopting a vision and values statement for delivery of services at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice