Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Winifred Helen McManus on 23 June 2015. The overall rating for the practice was good, although the practice was rated as requires improvement for providing safe services. The full comprehensive report for the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Winifred Helen McManus on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 15 December 2017 to review in detail the actions taken by the practice to improve the quality of care. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

The practice is rated as requires improvement for providing safe services, and overall the practice is rated as good.

Our key findings at this inspection were as follows:

• At our previous inspection on 23 June 2015, we told the provider that they should make improvements in some areas. These included the arrangements for a legionella risk assessment of the practice, infection control, appraisals and recruitment checks. We saw at this inspection that some improvements had been made.
• A legionella risk assessment had been completed.
• Overall the practice appeared clean and hygienic, however, the practice had not completed an infection control audit.
• The practice manager had been provided with an appraisal. However, no other staff had been appraised since the practice manger was appointed in October 2015.
• Appropriate recruitment checks had been completed for the two most recently employed members of staff at the practice.

There were areas of practice where the provider needs to make improvements as they are in breach of regulations.

Importantly, the provider must:

• Ensure care and treatment is provided in a safe way to patients (See Requirement Notice Section at the end of this report for further detail).
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties (See Requirement Notice Section at the end of this report for further detail).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Requires Improvement overall. (Previous rating 06 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

We carried out an announced comprehensive inspection at Dr Winifred Helen McManus (also known as Albert Rd Surgery) on 27 September 2018, as part of our inspection programme, and to follow up on breaches of regulations.

At a previous follow up inspection in December 2017 we found regulatory breaches around the areas of infection control and staff appraisals, and the practice was rated as requires improvement for providing safe services, with an overall rating of good.

At this inspection we found:

• The practice had some systems in place to manage risk so that safety incidents were less likely to happen, however not all risks had been identified and risk assessments were not kept sufficiently under review.
• Staff knew how to report incidents and safety concerns and felt confident doing so, however there was insufficient documented learning and action points to show improved processes to prevent the same incident happening again.
• The practice carried out some monitoring around the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Due to staffing difficulties, the practice had become heavily reliant on locum cover. Whilst this was managed effectively, we did identify some areas with a need for increased oversight, such as receipt of test results.
• Staff were proactive in supporting people to live healthier lives.
• Staff involved and treated patients with compassion, kindness, dignity and respect. The majority of patient feedback was very complimentary.
• Patients found the appointment system easy to use and on the whole reported that they were able to access care when they needed it.
• The arrangements for governance and performance management did not always operate effectively. Risks were not always dealt with appropriately or in a timely fashion. Ongoing staffing difficulties meant that service delivery was reactive and focused on short-term issues. There was no clear strategic plan.
• Staff and other stakeholders told us that where they had raised concerns or feedback, this was dealt with in an open and transparent fashion, and changes made where possible.

We saw one area of outstanding practice:

• The practice had a longstanding system for weekly open-access baby clinics, which catered for both well and sick babies. Parents could choose to have their baby seen by the nurse, GP or both without the need for an appointment. Services offered at the clinics included well baby checks, immunisations, children under 5 who were unwell, and postnatal checks. Childhood immunisation uptake rates were above the target percentage of 90%.

The areas where the provider must make improvements are:

• The provider must ensure that staff receive the immunisations that are appropriate to their role, and be able to demonstrate that staff have received occupational health assessment or pre-employment assessment which includes review of their immunisation needs.
• The provider must develop assurance and auditing systems and processes, to effectively assess, monitor and mitigate risks. This includes demonstrating learning and action points from safety incidents or risk assessments, and ensuring practice policies and procedures are comprehensive and regularly reviewed.

The areas where the provider should make improvements are:

• Instigate process to ensure urgent results are actioned and checked before the end of the day.
• The provider should ensure the secure storage of medicines.
• Continue to develop a programme of two cycle clinical audit which is clearly linked to driving improvement in patient outcomes.

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.