We carried out an announced comprehensive inspection at Birchwood Medical Practice on 5 February 2019 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 have rated this practice as requires improvement overall.

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

• The practice could not demonstrate that they always carried out appropriate staff checks at the time of recruitment and on an ongoing basis.
• Infection prevention and control (IPC) was not always well managed.
• The practice did not always have systems for the appropriate and safe use of medicines.

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

• Not all staff had received regular appraisals.

We rated the practice as requires improvement for providing well-led services because:

• Staff stated they felt respected, supported and valued within their own teams, but not always by management and members of the management team were not always available.
• Staff told us that not all management and lead roles were covered effectively during practice opening hours.
• The practice did not have clear and effective processes for managing risks, issues and performance.

These areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as good for providing caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice supported patients who were carers and had a dedicated member of staff as a carers champion.
• The practice offered services to meet patients’ needs. This included a bereavement counsellor delivered by a local hospice and regular support groups organised by volunteer health champions.
• The practice had named GPs for patients who were frail, elderly or receiving palliative care. They also had a named GP for nursing homes.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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

The areas where the provider should make improvements are:

• Strengthen the processes in place to document the ongoing monitoring and actions in response to concerns about vulnerable patients.
• Continue to monitor and act upon patient feedback regarding access to appointments and to ensure all patients are treated with kindness, respect and compassion.
• Implement plans to improve practice performance in monitoring patients with hypertension.

Details of our findings

At this inspection we found:

• We received positive feedback from patients who said they were treated with compassion, dignity and respect. They commented that they were involved in their care and decisions about their treatment.
• There were processes to identify, understand, monitor and address current and future risks including risks to patient safety. However, some of these processes were not implemented effectively. For example; recruitment processes and ongoing monitoring of clinical staff registration, staff appraisals, production of patient specific directions, and infection prevention and control.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients found the appointment system easy to use and reported that they were mostly able to access care when they needed it. This included access to online video consultations with another provider.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and most staff felt supported. However, this was not always by the management team. All staff spoke positively about working at the practice.

We saw two areas of outstanding practice:

• The practice had a number of additional services available for registered patients. This included access to a bereavement counsellor who offered up to six sessions. We saw that between May 2016 and September 2017 they had taken a patient survey, which showed that 85% of respondents felt the service highly met their expectations. This also showed that 92% felt the service was very easy to use.

• The practice had volunteer health champions who organised and delivered regular coffee mornings for all patients every two weeks and a monthly carers support group. The group was well attended and we saw health champions assisting patients including general discussions, how to get online, and support with completing application forms. The health champion leader told us they planned to expand on their work by arranging health walks, health and lifestyle education (such as diabetes and healthy-eating suggestions) and games.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Birchwood Medical Practice on the 4 February 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.

• Risks to patients were assessed and well managed.

• The practice has named GPs for the frail elderly and palliative patients.

• The practice has a named GP for their nursing homes.

• 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.

• Feedback from patients about their care was consistently positive. 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.

• Patients said that there were urgent appointments available the same day but sometimes was difficult getting through to the surgery by telephone.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

• The practice operated a wraparound service for patients whom the practice became aware of being vulnerable in any way, for example patients who had been diagnosed with a terminal illness. The practice provided a named administrator and GP and continued this wraparound service until the patient or relative felt stronger and could cope.

The areas where the provider should make improvements are:

• Ensure that the process to register to provide maternity and midwifery services with CQC is completed.

• Continue to review the quality of care that patients with asthma, diabetes and hypertension receive and the uptake of cervical cytology.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our visit we spoke with four patients, four members of staff and a trainee GP. We observed people who received treatment and viewed patient records.

We saw staff treated patients with respect, for example calling people by their preferred names. We saw that staff closed doors of the treatments rooms that provided privacy and dignity to patients. All of the patients that we spoke with told us that they felt respected by the staff at the practice. One patient told us “I’ve had nothing but good experiences.”

Patients that we spoke with told us that they felt involved in their care and treatment. We saw that staff discussed treatment options with patients and updated their records after each appointment. Patients told us that they were able to make appointments easily. They said they may not always get to the GP they wanted but were happy with the treatment they received with whoever was available to see them.

We found that staff were aware of procedures around safeguarding vulnerable adults and children. We saw that the practice had safeguarding policies that related to adults and children and there was a lead contact for each of these at the practice.

The practice had systems in place that monitored the quality of the service and to identify when things needed to be improved. We found that patient’s views were taken into account to improve the practice for patients.