We carried out an announced comprehensive inspection at Carlton Group Practice on 11 February 2019. The announced inspection was 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 did not have risk assessments in place in relation to medicines for use in the event of an emergency not held at the practice sites.
• The practice had not ensured that both practice premises had appropriate documented health and safety and security risk assessments in place. However, an external company was employed to undertake these assessments on 15 February 2019.
• The systems, processes and practice that helped to keep patients safe and safeguarded from abuse were insufficient. In particular that their safeguarding policies did not reflect current national updates. They had not implemented a system to monitor and follow up children who did not attend their appointment following referral to secondary care.
• Infection Prevention and Control processes had not been adequately applied at the King Street site.
• Staff had not been in receipt of all training appropriate for their role according to the practice’s policy and protocols.

We rated the practice as requires improvement for providing a caring service because:

• Patients were less positive than the local CCG and England averages in being treated with care and concern and their confidence and trust in the healthcare professional they saw or spoke to.
• Only 0.7% of registered patients were electronically coded as being a carer.

We rated the practice as requires improvement for providing a well led service because:

• There were gaps in the practice’s governance systems and processes.
• The practice had not shared or documented a sustainable practice business plan or strategy.
• There was a lack of oversight on the maintenance of accurate records of skills, qualifications and training for staff and in staff appraisals.

We rated the practice as good for providing effective services because:

• 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.
• The practice understood the needs of its population and tailored services in response to those needs. There was evidence of a number of projects and services the practice had been involved with to ensure patients’ needs were met.

We rated the practice as good for providing a responsive service because:

• The practice had acted on the National GP survey findings and implemented a number of changes. These included a new telephone system, staffing reviews, various ways of making and cancelling appointments and appointment options such as shorter five-minute single problem appointments as well as normal appointments and telephone GP consultations.
• The complaint policy and procedures were in line with recognised guidance, trend analysis and learning was derived from these incidents.

These areas affected all population groups, so we rated all population groups as good, with the exception of families, children and young people which was rated requires improvement in effective and therefore rated as requires improvement overall.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure the proper and safe management of medicines in particular emergency medicines.
• Ensure the practice premises have appropriate documented health and safety and security risk assessments in place.
• Ensure there are effective systems, processes and practice that help to keep patients safe and safeguarded from abuse.
• Ensure that persons providing care or treatment to service users have the qualifications, competence, skills and experience to do so safely.

The areas where the provider should make improvements are:

• Implement safeguard policy updates in line with local and national guidance changes.
• Develop the staff training matrix which enables clear oversight on all staff training.
• Consider obtaining lockable metal cabinets for patient paper records security at the Carlton Street site.
• Further develop the significant event system to include non-clinical staff at meetings.
• Continue to improve the practice carer register numbers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected this service on 13 October 2014 as part of our new comprehensive inspection programme.

The overall rating for this service is good. We found the practice to be good in the safe, caring, effective, responsive and well-led domains. We found the practice provided good care to older people, people with long term conditions, families, children and young people, working age people, people in vulnerable groups and people experiencing poor mental health.

Our key findings were:

• Performance was consistent over time and patients were kept safe because there were arrangements in place for staff to report and learn from incidents that occurred.
• Patients received evidence based assessments and care and treatment was planned and delivered to promote a good quality of life
• Staff treated patients with respect and kindness. Patients told us that staff were caring and compassionate. They said that they had confidence and trust in the GPs they saw or spoke with.
• Services were planned and delivered to meet the needs of the patients. The practice was aware that improvements were needed to the appointments system to enable improved access for patients. Some changes have been made to the call back system for patients and this was being closely monitored
• The leadership and management within the practice promoted an open and transparent culture. Staff felt supported and able to contribute to the running of the service. The practice sought and acted on feedback from staff and patients

An example of outstanding practice that we saw was:

• The practice had implemented a new initiative in conjunction with the Clinical Commissioning Group (CCG) which involved employing and developing newly qualified nurses and nurses new to practice nursing. This was a proactive approach to begin to address the future skill gaps in the workforce in general practice.

We identified one area for improvement. The provider should:

• Develop staff knowledge of the Mental Capacity Act 2005 in relation to their roles

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice