This practice is rated as Good overall. (Previous rating April 2015 – Outstanding)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Good

We carried out an announced comprehensive inspection at Boundary House Medical Practice on 1 October 2018 as part of our inspection programme.

At this inspection we found:

• The practice had strong 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 habitually 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.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding responsive practice :

• The practice was very responsive and arranged its services to meet the requirements of the patients as much a possible. For example, they introduced Walking for Health – with 15-20 people walking weekly. They now have five patients trained as walk leaders. The scheme was so successful it is now part of a development across Trafford helping other GP surgeries to facilitate their own walking groups.
• In response to meeting with a patient, the practice undertook an audit to identify patients on the autistic spectrum. A significant number were not receiving structured health checks because of their lack of engagement. As a direct result, specific structured invites were sent and the practice now provided structured invited health checks for all patients on the autistic spectrum.
• Specific training was provided to a member of staff when patients suggested that extra help was required for those with mental health conditions. Coffee/tea mornings and exercise groups were introduced to combat loneliness in the community. Fundraising was undertaken to raise money for a community defibrillator after the one at the practice was borrowed on several occasions. Collections for the local food bank were organised and five deliveries had been provided.
• A free acupuncture service was offered resulting in lower prescribing for pain relief medicines and lower referrals to secondary care services
• Overall, we saw that the practice responded wholeheartedly to suggestions and advice it received from its patients.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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

Letter from the Chief Inspector of General Practice

We inspected Boundary House Medical Centre on the 22nd January 2015 as part of our comprehensive inspection programme.

From all the evidence gathered during the inspection process we have rated the practice as outstanding.

The provider was rated as outstanding for effective, responsive and well led which led to this rating applying to older people, people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia) population groups. We rated safe and caring as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example working in partnership with the community matrons, drug and alcohol workers and participating in research such as the Salford Lung Study to improve outcomes for patients.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• A children’s immunisation and vaccination programme was in place. The practice was achieving high levels of child immunisation including the MMR a combined vaccine that protects against measles, mumps and rubella, Hepatitis C and Pertussis (whooping cough). The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

• We found the practice proactively engaged in research and clinical studies to inform good practice and looking at new ways to improve outcomes for patients. We saw the practice was involved in the Salford Lung Study and an Asthma study. Initial results showed positive impact on patients who experienced fewer or no episodes of acute exacerbation.
• One GP provided a free acupuncture clinic for patients with various conditions such as muscular-skeletal conditions, migraine, fibromyalgia and chronic fatigue syndrome. Audits showed a 70% response rates with reduced referral rates to secondary care and a reduction in prescribing costs.
• We saw from The Quality and Outcomes framework (QOF) data for 2013/14, 91% of patients with poor mental health had a comprehensive care plan documented in the records agreed between individuals, their family and/or carers as appropriate, above the local CCG average. We saw care plans were also in place for patients at risk of unplanned hospital admissions and those aged 75 and over who were vulnerable.
• We reviewed the most recent data available for the practice on patient satisfaction. This included information from the national patient survey 2013/14, a survey of 198 patients undertaken by the practice’s patient participation group (PPG) and the friends and family test. The evidence from all these sources showed patients were satisfied with how they were treated and that this was with compassion, dignity and respect. For example, data from the national patient survey showed 95% of respondents described their overall experience of this surgery as good and 94% said the last nurse they saw or spoke to was good at treating them with care and concern.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice