We carried out an announced comprehensive inspection at Bredbury Medical Centre on 26 February 2019 as part of our inspection programme.

Our inspection team was led by a CQC inspector and included a GP specialist advisor.

At the last inspection published in October 2017 we rated the practice as good overall.

Our judgement of the quality of care at this service is based 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.

The practice is rated as good overall. We rated the practice as good for providing safe, effective, caring, responsive and well-led services.

This means that:

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

There were areas where the provider should make improvements:

• Maintain a management oversight of some processes, for example professional registrations, safety alerts and the recording of consent.
• Review use of care planning arrangements for vulnerable patients
• Update the GP locum pack.
• Review and update whistleblowing processes.

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

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously inspected Bredbury Medical Centre in October 2015 and the practice was rated as requiring improvement overall. We found there were gaps in assessment and management of risks and that governance arrangements were not comprehensive. We carried out a further announced comprehensive inspection at the practice on 8 November 2016 where we found continued concerns and that appropriate action had not been taken. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months following the publication of the inspection report. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Bredbury Medical Centre on our website at www.cqc.org.uk.

Following the inspection in November 2016 we issued one warning notice and imposed a condition on the registration of the provider. These required the provider to take action to improve the quality of service provided and to provide the CQC with monthly progress reports. This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 26 July 2017. Overall the practice is now rated as good.

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

• Previously the practice had not taken action to improve the service they provided. This inspection provided evidence that the practice had taken action and had implemented a programme of effective improvements.
• We identified previously a number of areas of potential risk to both patients and staff including the lack of risk assessments for fire safety, legionella and infection control and prevention. Evidence at this inspection demonstrated that safe effective systems had been implemented to address these areas.
• Appropriate recruitment checks were now in place for all staff
• Systems to securely store and monitor the use of prescription paper had improved.
• Instructions to enable nurses to administer medicines safely were signed and dated by GPs and the practice nurse.
• Systems to recognise, record, and respond to significant events had improved and these were supported by an incident policy. Evidence was available that demonstrated outcomes and learning from significant events and complaints were shared.
• Governance arrangement had improved significantly and there was a clear staffing structure with identifiable roles and responsibilities.
• Records of staff training showed that staff had benefited from a range of training including fire safety and safeguarding. Additional training was planned.
• Action continued to ensure the practice had appropriate policies and procedures available for staff and team meeting minutes demonstrated these were shared and discussed with all the practice team.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• Systems to improve patient feedback had been implemented and this included developing the patient reference group, and providing patients with opportunities to make suggestions, compliments, and complaints.

The areas where the provider should make improvement are:

• Continue to improve achievements with screening of patients including those with long term conditions, cervical screening and cancer screening.
• Implement a planned programme of clinical audit and re-audit.
• Continue to promote and develop the patient participation group for the practice.
• Continue efforts to identify patients who have caring responsibilities in order to facilitate their access to appropriate support.

I am taking this service out of special measures.

This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously inspected Bredbury Medical Centre in October 2015 and the practice was rated as requiring improvement overall. We found there were gaps in assessment and management of risks and that governance arrangements were not comprehensive. We carried out a further announced comprehensive inspection at the practice on 8 November 2016. Overall the practice is now rated as inadequate, as sufficient improvements have not been made and there are continued areas of concern.

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

• The practice had not undertaken the key action points it had said it would in order to improve following the previous inspection.

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment and actions identified to address concerns with infection control practice had not been taken.There were key gaps in risk assessment documentation in such areas as fire safety and legionella.

• Processes around medicines management were not comprehensive to ensure safety, for example there was no system in place to monitor blank prescriptions.

• There was limited evidence of learning and sharing outcomes with staff following the analysis of significant events.

• There was some evidence of clinical audit demonstrating quality improvement.

• While the GPs were able to discuss areas of weakness in the practice’s performance, they did not describe any action being put in place to address them.

• Patients were generally positive about their interactions with staff and said they were treated with compassion and dignity.

• There were continued gaps in the practice’s governance arrangements. There were some key gaps in policy guidance and not all staff were aware of their location. We also found evidence indicating that the practice did not consistently follow its own documented policies and procedures.

• There was a lack of managerial oversight of staff training which had resulted in key omissions, for example only two staff had received fire safety training.

• Learning from complaints was not consistently shared and one patient expressed dissatisfaction with how a verbal complaint they had raised had been handled by the practice.

The areas where the provider must make improvements are:

• Introduce more comprehensive processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

• Take action to address identified concerns with infection prevention and control practice.

• Improve systems around medicines management so that blank prescriptions are logged and their location monitored and patient group directions available to staff are appropriately signed to demonstrate authorisation.

• Ensure staff training is undertaken and appropriately managed to ensure all staff have completed training and have the skills and qualifications to carry out their roles.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

• Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.

• Ensure the complaints policy is followed in practice when handling patient’s concerns and complaints.

The areas where the provider should make improvement are:

• Undertake activity to engage patients further in providing feedback on services offered.
• Continue efforts to identify patients who have caring responsibilities in order to facilitate their access to appropriate support.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

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 Bredbury Medical Centre on 7th October 2015. Overall the practice is rated as requires improvement.

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

• Risks to patients were not assessed or managed appropriately. No risk assessments for areas such as fire safety or lone working had been carried out. Appropriate recruitment checks had not been completed for new members of staff.

• The practice did not have an effective system in place to monitor and manage the training needs of its staff.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded and analysed, however lessons learned were not widely disseminated to staff.
• Data showed patient outcomes were in line with averages for the locality.
• Some audits had been carried out, and the practice could demonstrate how they had implemented changes following these and were measuring the improvements to patient care.
• 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.

• Urgent appointments were usually available on the day they were requested. Patients were positive about their ability to access appointments.
• The practice had a number of policies and procedures to govern activity, but some of these were out of date or not fully relevant to the operation of the practice.

Action the provider MUST take to improve:

The areas where the provider must make improvements are:

• Implement a more effective, systematic approach to identifying and managing risks within the practice.
• Implement a more systematic approach to recording staff training. Staff must receive appropriate training in areas such as safeguarding, fire safety and infection control.
• Ensure recruitment arrangements include all necessary employment checks for all staff, as well as checks for membership with appropriate professional bodies for clinical staff.
• Ensure the policies and procedures that are available to staff are up to date and accurate.

Action the provider SHOULD take to improve:

In addition the provider should:

• Ensure all clinical staff have appropriate medical indemnity insurance as required.
• Utilise alerts on the electronic record system to identify at risk or vulnerable patients to clinicians in order to maximise their opportunity to receive the appropriate care.
• Ensure the infection prevention and control lead has received sufficient training to carry out the role
• Implement systems to improve medicines management.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

When we inspected Bredbury Medical Centre in August 2013 we found that improvements were needed to ensure that people were protected and kept safe at all times when receiving services from the medical centre or its staff. Following our visit the provider prepared an action plan which indicated that appropriate arrangements would be in place by April 2014.

We carried out this inspection to follow up on actions taken by the provider to ensure people were safe.

We looked at the premises and at records and documents relating to staff and training.

We found that improvements had been made in each of the required essential standards including the training of staff in safeguarding people, the provision of fire action signs and smoke detectors and the checks on staff employed had been carried out.

When we visited the Bredbury Medical Centre we looked around the surgery and we spoke with four patients who had attended for appointments that day.

The patients told us that the doctors always explained their treatment to them and in particular discussed any effects or side-effects that the medicines prescribed might have.

We talked briefly to two of the three of the doctors who practised at the surgeries. Their time and commitments did not permit very detailed discussions with us. We also talked at length to surgery staff and we talked with nursing staff on duty in the surgery.

We looked at the arrangements for safeguarding patients from abuse, but we were not able to find evidence at the time of the inspection that the practice had put roles, training and procedures in place to ensure that they met the requirements of this regulation.

We looked at arrangements for requirements relating to workers. Staff records did not provide evidence that sufficient checks had been made about the suitability of employees.

We looked at the safety and suitability of premises and found that some improvements were required to ensure its suitability and safety.

We carried out an announced comprehensive inspection on Bredbury Medical Centre on 26 July 2017. The overall rating for the practice was good, although the practice was rated as requires improvement for effectiveness. The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link for Bredbury Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 19 February 2018 to confirm that the practice had carried out their plan to make improvements following the last inspection

The practice is now rated as good for effective services, and overall the practice is rated as good.

Our key findings were as follows:

• The practice had improved achievements with the screening of patients.
• A programme of clinical audit and reaudit was now in place.
• Recommendations made at the previous inspection, such as promotion of the patient participation group and carers register continued.

The areas where the provider should make improvements are:

• Continue work to identify and support patients who have caring responsibilities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice