This practice is rated as Good overall. (Previous inspection 10/02/2015 – 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

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Barrington Medical Centre (Dr B N Macdonald and Partners) on 15 March 2018.

At this inspection we found:

• The practice had clear systems to manage risks 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.

• The practice had an effective programme of continuous clinical and internal audits. The audits demonstrated quality improvements and staff were actively engaged in monitoring and improving patient outcomes as a result.

• The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.

• Staff involved patients and treated them 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.

• The practice had virtual patient participation group.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw an area of outstanding practice:

• The practice offered a considerably enhanced service to identify and manage patients with pre-diabetes and/or gestational diabetes before the condition became enhanced. In-house diabetic clinics were personalised and there was a close working relationship with GPs and nurses to the benefit of the patients.One of the administration staff had a systematic review and recall arrangement and ensured that attendance of appointments was monitored.Appointments were co-ordinated with other chronic diseases to minimise the amount of disruption to patients. The length of appointment ranged from 20 minutes to 80 minutes dependent on the requirements and patients and carers could attend appointments together.In addition a supportive information pack had been pulled together on the initiative of one of the clinicial staff.It contained leaflets about management and control, a range of contact numbers, a six week guide, and magazines sourced from different diabetes support groups.

The areas where the practice should consider improvements are as follows :

• The practice should ensure that all staff who are performing chaperone duties have undergone a Disclosure and Barring Service (DBS) check or risk assessment.

• The practice should endeavour to structure meeting agendas so that items such as significant events, complaints, safeguarding and governance issues are consistently raised for discussion.

• Information on the website was outdated and would benefit from a review. For example the complaints policy mentioned the Healthcare Commission and PCT which no longer exist.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Dr BN Macdonald & Partners practice at Barrington Road, Altrincham Cheshire.

We carried out a comprehensive inspection on 19 January 2015. We spoke with patients, members of the patient participation group and staff, including the management team.

The practice was rated as good overall. A safe, caring, effective, responsive and well-led service was provided that met the needs of the population it served.

Our key findings were as follows:

• All staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal incidents were maximised to support improvement.
• Feedback from patients was positive.
• The practice were using proactive methods to improve patient outcomes We found an open culture and evidence that staff were motivated and inspired to provide kind and compassionate care.
• The practice had a clear vision which had quality and safety as top priorities. This vision was owned by all the practice staff with evidence of team working across all roles. The leadership culture was open and transparent. We found high levels of staff satisfaction. There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• Patients told us they are treated with compassion, dignity and respect and they are involved in care and treatment decisions.
• The practice implemented suggestions for improvements and makes changes to the way it delivers services as a consequence of feedback directly from patients and from the Patient Participation Group (PPG).

We saw several areas of outstanding practice including:

• Recall systems for long term conditions were effectively managed in a timely manner by dedicated staff to ensure appropriate management of patient’s conditions. Staff could demonstrate they had recalled all patients with long term conditions for their annual reviews.
• Care of patients with long term conditions was patient focussed and fully responsive to their needs with individual care plans implemented to ensure their needs were fully met at a time when they most required it. This had led to a reduced attendance at A&E in a small group of patients who were vulnerable due to their long term conditions.
• We were given numerous examples of the practice responding to feedback from their Patient Participation Group and taking action to improve the service. These included supplying distraction equipment such as MP3 players for anxious patients prior to minor surgery.

In addition the provider should:

• Ensure there is an auditable system for reviewing and monitoring the recording of serial numbers on blank hand written prescriptions pads held in storage and once allocated to GPs.
• Ensure safeguarding flags are evident on all relevant patient records when records are opened.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice