This practice is rated as Good overall. Previous inspection May 2015 - Good

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Dalston Medical Group on 22 May 2018 as part of our inspection programme.

At this inspection we found:

• The practice had systems to keep patients safe and safeguarded from abuse.
• 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 they provided. They 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 organised and delivered services to meet patients’ needs. They took account of patient needs and preferences.
• Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.
• There was a focus on continuous learning and improvement at all levels of the organisation. The practice proactively used performance information to drive improvement.

However, there are areas where the provider should make improvements:

• The provider should be more proactive in their identification and support of carers
• They should consider having a documented business plan
• They should improve current processes so that learning and trends and themes arising from significant events and incidents are shared with all staff at regular minuted meetings as a standard agenda item
• They should continue in their efforts to establish a patient participation group (PPG)

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

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Dalston Medical Centre on 7 May 2015

Overall, we rated the practice as good. Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well led services.

Our key findings were as follows:

• We had inspected the practice previously during May 2014. We identified a number of areas of concern. During this inspection we found significant improvements had been made; all of the areas we identified as concerns had been addressed and changes to practice made where necessary;
• Feedback from patients was positive; they told us staff treated them with respect and kindness;
• Patients reported good access to the practice, with urgent appointments available the same day;
• Most of the patients we spoke with told us they felt they had sufficient time during their appointment, although some said they felt rushed at times;
• Patients’ needs were assessed and care was planned and delivered following best practice guidance;
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed;
• A detailed review of patient access had been carried out and as a result the GPs had revised their working days, additional appointments had been made available each day and emergency appointments with all GPs were set aside each day;
• There was a clear leadership structure and staff felt supported by the management team. The practice actively sought feedback from patients;
• The practice was clean and hygienic, and good infection control arrangements were in place.

However, there was an area of practice where the provider needs to make improvements.

The provider should:

• Take steps to implement effective arrangements for monitoring staff’s Hepatitis B immunisation status.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Dalston Medical Group provided services from The Surgery. The Surgery provided a weekday service for over 5000 patients in the Carlisle area. The Surgery open Monday to Friday from 08:30 to 18:30 and had recently introduced appointments at 07:30 but the days this was available varied each week. The service was responsible for providing primary care, which included access to GPs, minor surgery, family planning as well as ante and post natal care. Cumbria Health on Call (CHOC) provided an out of hours service for patients who used the Surgery.

The patients we spoke with and who completed our comment cards were extremely complimentary about the care and treatment being provided. Patients reported that all the staff treated them with dignity and respect. They found the doctors and nurses had a good understanding of their needs.

We found that action was needed to improve the provider’s involvement of patients in the development of the service.

We found that staff required appropriate training. Clinical governance processes needed to cover checking competency of clinicians. Recruitment procedures needed to be strengthened.

The arrangements for maintaining the building to a safe standard needed to be in place. The service was not cleaned to an appropriate standard.

Governance and risk management measures were not in place and many quality assurance systems needed to be developed. We found that the provider was not meeting eight of the regulations.

We told the provider they must make a number of improvements.