This practice is rated as Good overall. (Previous rating January 2018 – Good)

The key questions at this inspection are rated as:

Are services safe? – Not inspected

Are services effective? – Not inspected

Are services caring? – Not inspected

Are services responsive? – Not inspected

Are services well-led? - Good

We carried out an announced focused inspection at Dr Clarke and partners on 13 September 2018. The inspection was carried out to follow up on breaches of regulations and to review that the practice had addressed the areas for improvement found in our previous inspection in January 2018. This report covers our findings in relation to those areas.

At this inspection we found:

• The practice had made improvements in systems and processes to manage risk and had assured themselves health and safety checks had been completed.
• They had implemented improved recruitment policies and procedures.
• They had acted to improve patient experience when making an appointment.
• Appraisal records had been completed.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Clarke and Partners on 23 June 2015. The overall rating for the practice was good with requires improvement for being safe.

We carried out an announced focused inspection on 9 March 2017 to review that the practice had addressed the areas for improvement recommended in our previous inspection on 23 June 2015. Overall the practice was rated as Good and requires improvement for being well-led.

The reports for the inspection on the 23 June 2015 and 9 March 2017 can be found by selecting the 'all reports' link for Dr Clarke and Partners, Wickersley Health Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 24 January 2018 to review that the practice had addressed the areas for improvement found in our previous inspection on 9 March 2017. This report covers our findings in relation to those areas.

Overall the practice is rated as Good and requires improvement for being well-led.

Our key findings were as follows:

• Arrangements for provision and monitoring staff training had improved.

• Actions identified as part of health and safety risk assessments had been monitored and acted upon in a timely manner.

• The recruitment polices and procedures had not been followed and the recruitment policies and procedures were not sufficiently detailed to ensure fit and proper persons were employed.

• The practice had developed systems for the practice to monitor their performance. They provided evidence they were closely monitoring Quality Outcome Framework (QOF) results as these had been lower than average in 2016/17. (QOF is a system intended to improve the quality of general practice and reward good practice). Additional staff had been employed to assist them to meet these targets.

• The practice had also taken into account the lower than average results from the annual GP Patient survey for patient experience in making an appointment. They had reviewed the appointment system and changed the balance of walk-in appointments and pre-bookable appointments to try to improve patient experience of pre-booking an appointment. They had also provided more appointments for patients to access on line. They had implemented care navigation systems to help advice and signpost patients to a more appropriate service or person to best help them. Staff involved in this system had received training for this role and an additional member of staff had been employed to assist the reception staff at busy times of day. Opening hours had also been increased both in the morning and evening and the practice was now open from 8am to 6.30pm.

There were areas of practice where the provider must make improvements:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

There were areas of practice where the provider should make improvements:

• Fully complete the appraisal records.

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 Dr Clarke & Partners on 23 June 2015. The overall rating for the practice was good with requires improvement for being safe. The full comprehensive report on the 23 June 2015 inspection can be found by selecting the ‘all reports’ link for Dr Clarke & Partners, Wickersley Health Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 9 March 2017 to review that the practice had addressed the areas for improvement recommended in our previous inspection on 23 June 2015. This report covers our findings in relation to those areas since our last inspection. 

Overall the practice is rated as Good and requires improvement for being well-led.

Our key findings were as follows:

• At our previous inspection on the 23 June 2015, we found that staff had not carried out the appropriate recruitment checks prior to the staff commencing work. For example, staff had not carried out a Disclosure and Barring Service (DBS) check for a GP who had started work prior to the inspection. At this inspection, we found the practice manager had applied for the DBS check for the GP on 1 March 2017. The practice manager told us that following the inspection no further staff had commenced work. One member of staff had been interviewed and was to commence work, and the practice was awaiting all of the recruitment records to be completed.
• At the previous inspection on the 23 June 2015, the building was managed by NHS property services and they were responsible for carrying out all of the repairs and maintenance. However, the practice had not identified a named person who was responsible for legionella risk assessment and management. (Legionella is bacterium, which can contaminate water systems in buildings). The practice manager received a copy of the most recent legionella risk assessment from NHS property services prior to our visit, However, they had not contacted them to check if they had completed all of the actions in the report.
• At the previous inspection, we noted the resuscitation guidelines in the emergency equipment bag were dated 2005 and were not the most recent. At this inspection, we found that they were up to date and staff had completed basic life support training.

However, there were also areas of practice where the provider must make improvements.

• Ensure staff have regular access to and complete training relevant to their role.
• Ensure a fire evacuation drill is performed and staff complete fire training.
• Ensure actions identified as part of risk assessments are monitored and acted upon in a timely manner.

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 Dr Clarke and Partners’ on 23 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for all the population groups. It required improvement for providing safe services.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received some training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• Patients said they found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• Some risks to patients were assessed and managed, with the exception of those relating to legionella, recruitment checks and infection prevention control.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure all staff completed infection prevention control training relevant to their role.
• Ensure actions identified from the legionella testing are implemented in accordance with the findings.

• Ensure the most up to date resuscitation guidelines are available to staff.

• Ensure fire evacuation drills are performed in line with statutory requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice