Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall. (Previous inspection February 2015, rating - Good).

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

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 recently 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 Bolton House Surgery on 11 December 2017. The inspection was carried out as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.

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

• The practice recognised that the patient’s emotional and social needs were as important as their physical needs.

• Recruitment procedures were not fully established and some staff recruitment files were found to be incomplete.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Some members of staff had not been provided with appropriate training, such as safeguarding and fire training.
• An effective process had not been established for the on-going appraisal of staff.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure that training, learning and development needs of staff members are identified and reviewed at appropriate intervals during the course of employment.

• Ensure an effective process is established for the on-going appraisal of all staff employed at the practice.

• Ensure that necessary recruitment checks are in place for all staff and the required specified information in respect of persons employed by the practice is held.

• Ensure that an adequate governance system is in place to manage the assessing, monitoring and mitigation of risks relating to the health, safety and welfare of patients.

The areas where the provider should make improvements are:

• Review the availability of emergency medicines to manage medical emergencies giving due regard to guidelines issued by the British National Formulary and the Resuscitation Council (UK).

• Implement and maintain a schedule of regular practice meetings to include all staff members and ensure that these are minuted.

• Encourage the contribution of ideas and decision making from staff at all levels in order to drive improvement.

• The practice should continue their work in improving the delivery of immunisations to children.

• Encourage the involvement and engagement of GPs at PPG meetings.

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 of this practice on Tuesday 16 December 2014. Breaches of legal requirements were found in relation to the safe management of medicines.  After the comprehensive inspection, the practice wrote to us to say what they would do to meet legal requirements. We undertook this focused inspection on 23 October 2015 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

Our previous report also highlighted areas where the practice should improve:-

• Provide training to all staff on infection control and ensure that infection control is covered in the induction for all new staff.

• Undertake a formal risk assessment of the health and safety of the building on a regular basis which identifies the actions required to mitigate any risks.

• Provide training for all staff on safeguarding vulnerable adults.

• Ensure all staff have an annual appraisal which is agreed and documented.

Our key findings across the areas we inspected for this focused inspection were as follows:-

• Blank prescription forms were now handled in line with current guidance from NHS Protect.

• All staff had received training on infection control. Infection control was now included in the induction of new staff.

• The practice had undertaken a formal up to date risk assessment of the building and practice environment.

• All staff had received training on safeguarding vulnerable adults.

• All staff had had an up to date annual appraisal.

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 Bolton House on 16 December 2014. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing effective, responsive, caring and well led services. However, it was rated as requires improvement in relation to providing safe services. The practice was rated as good for providing services to people with long term conditions, families, children and young people, working age people, people whose circumstances make them vulnerable and for services for people with mental health problems including those with dementia.

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

• The practice had a system in place for reporting, recording and monitoring significant events, incidents and accidents. There was evidence that the practice had learned from these and that the findings were shared with relevant staff.
• Patient feedback was positive. Patients said they were treated with compassion, dignity and respect. They said they felt listened to and that they were involved in decisions about their care and treatment.
• The GPs ran personal lists which helped ensure patients always saw their own GP.
• The practice was responsive to the needs of its patients. In particular it understood the need to provide information in other languages to meet the needs of its non-English speaking patients.
• Staff felt well supported by management and told us they had good access to training.
• Improvements were required to the practice premises in order to make it more suitable for providing safe and accessible and modern primary care services.

There were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Handle blank prescription forms in line with current guidance from NHS Protect.

In addition the provider should:

• Provide training to all staff on infection control and ensure that infection control is covered in the induction for all new staff.
• Undertake a formal risk assessment of the health and safety of the building on a regular basis which identifies the actions required to mitigate any risks.
• Provide training for all staff on safeguarding vulnerable adults.
• Ensure all staff have an annual appraisal which is agreed and documented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bolton House Surgery on 11 December 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the December 2017 inspection can be found by selecting the ‘all reports’ link for Bolton House surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection at Bolton House Surgery on 19 September 2018. This was to follow up on breaches of regulations identified at our inspection of 11 December 2017 (published 06 February 2018).

This practice is now rated as Good overall. (Previous rating in February 2018 – Requires improvement)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. However, there were some areas around fire safety that required improvement.
• There was an effective recruitment and induction system for new staff.
• Staff had received training including safeguarding training, appropriate to their role.
• All staff received regular appraisals and support.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Provide awareness training for all staff on the ‘red flag’ sepsis symptoms that might be reported by patients and how to respond.
• Continue to review and improve the levels of exception reporting in the quality and outcomes framework and the uptake for cervical screening.
• Continue to review and improve the prescribing of hypnotic medicines where clinically appropriate.
• Review and improve the system to ensure the ongoing registration of clinical staff is checked and regularly monitored.
• Review and improve the identification of carers so that they can be offered appropriate support.
• Review and improve the audit trail to demonstrate that the action and learning from complaints, significant events and informal meetings has been shared.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice