Letter from the Chief Inspector of General Practice

We carried out a planned comprehensive inspection of Broken Cross Surgery, Waters Green Medical Centre on 4 December 2014.

We rated the practice overall as outstanding.

Our key findings were as follows:

• The practice was caring. Comments from patients about the practice, its staff and the care and treatment which they received were consistently and especially positive.
• The practice was responsive. The practice covered the Macclesfield town area. Though the town has a higher percentage of older people, Broken Cross Surgery has a relatively young patient population. The service given by the practice had been designed to meet the needs of its patient population.
• The practice was safe and effective. The practice had a strong focus on safety, putting patient’s needs first and continually learning from incidents. There was documented evidence of a strong track record of safety over time.
• The practice was well led. The practice had a clear vision to deliver high quality care and promote good outcomes for patients. There was strong leadership, governance arrangements and strategic vision within the practice.

We saw several areas of outstanding practice including:

• The services provided to vulnerable patients including those who were homeless, or facing challenges in relation to substance misuse or poor mental health received services had been tailored to deliver consistent quality of medical care to all irrespective of their personal circumstances.
• In addition to services provided the practice made exceptional arrangements to support patients including those who were homeless, or needed medical intervention and support in relation to substance misuse.
• Patients experiencing poor mental health received intervention and treatment from clinicians with particular expertise in this field and the care given had been tailored to meet individual needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

At the previous inspection on 4 December 2014 the practice was rated as outstanding for providing responsive and well led services and an overall rating of outstanding. Having now inspected all GP practices we have a better understanding of the baseline so what we assessed as being outstanding previously, now would not be rated as outstanding. This is because initiatives that were previously regarded as innovative or unusual may no longer be so because things have moved on in primary care

We carried out an announced comprehensive inspection at Broken Cross Surgery on 28 January 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 good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• There was a system in place for investigating and responding to patient feedback including complaints.

• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• There was a focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice including:

• We saw evidence of the practice providing support to vulnerable patients to build trust to encourage them to access the practice. The practice ensured that patients with a learning disability were supported by a named nurse to build trust, relationships and understanding of communication needs and methods.

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

• The majority of clinical staff did not have safeguarding training appropriate to their roles and responsibilities.
• Two Patient Group Directions (PGD) were examined and we found they had not been appropriately dated, signed and authorised. We noted that a staff members name had been added after the date it had been authorised by a GP

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Ensure that clinical staff have received safeguarding training at a suitable level to their role.

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

The areas where the provider should make improvements are:

• Review key policies and procedures at regular intervals to ensure they are in line with current legal requirements and best practice.
• Ensure that suitable infection control training or peer support is provided to the designated infection control lead.
• Ensure that the practice’s recruitment process considers an applicant’s physical and mental health in line with the requirements of the role.
• Ensure that fire drills take place at regular intervals.

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