Letter from the Chief Inspector of General Practice

This practice is rated as good overall. (At the previous inspection undertaken in October 2014, the practice also received a good overall rating)

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 Elmwood Medical Centre on 5 March 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• There was a clear leadership structure and staff told us they felt well-supported by the partners and practice manager. We observed the positive impact this had in establishing a well-integrated practice team with low staff turnover and high morale.
• GPs and practice staff worked effectively as a cohesive team and provided personalised and responsive care to their patients.
• There was an emphasis on a patient centred approach in all aspects of the practice’s work. This was underpinned by the practice’s values.
• Results from the 2017 national GP patient survey showed that the practice had performed either above or in line with local and national averages regarding patient experience. The results had increased in 19 of the 23 indicators since the last survey was undertaken in 2016.
• The national GP survey showed that 88% of patients who responded would recommend the surgery to someone new to the area compared with the clinical commissioning group (CCG) average of 81% and the national average of 77%. This was reinforced by the Care Quality Commission (CQC) comment cards completed by patients prior to our inspection, which reflected that patients were highly satisfied with the care they had received.
• The practice had a strategy and forward vision. They worked with their local CCG and practices to maximise improvements in primary care for local patients. For example, the practice were seeking a solution to NHS England’s requirementto ensure that patients had enhanced access to GP services, including appointments during evenings via an 8-8 service, and the provision of appointments at the weekend and bank holidays.
• There was a focus on continuous learning and improvement at all levels of the organisation. Staff training records were up to date, and regular appraisals encouraged development at all levels.
• The practice had an established quality improvement programme. This included a regular audit programme which demonstrated improvements in outcomes for patients.
• We found that the procedure for checking medicines within the practice was not sufficiently robust and we discovered two items of medicines and consumables that had exceeded their expiry date.
• The practice was able to demonstrate compliance with health and safety legislation. However, we observed one piece of broken equipment which had not been labelled or removed from a clinical room.
• The practice encouraged and supported staff to report incidents, although we found that there were generally low levels of incident reporting in the practice. There was some scope to enhance investigations into incidents and to share learning earlier and more widely.

The areas where the provider should make improvements are:

• Strengthen procedures to check for out of date medicines and consumables.
• Review the process for investigating incidents and sharing learning from significant events with all team members.
• Review the procedure for labelling and removing any broken equipment from clinical areas.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected Elmwood Medical Centre on 20 October 2014. The practice operates from 7 Burlington Road, Buxton, Derbyshire SK17 9AY. This was a comprehensive inspection.

This practice has an overall rating of good.

Our key findings were as follows:

• The service was safe in all areas. Staff understood their responsibilities to raise concerns and report accidents, incidents and near misses. Opportunities to learn from internal and external incidents were analysed and used to support improvement.
• The service was effective. Elmwood Medical Centre had sound clinical systems in place to ensure effective service delivery. This included regular clinical meetings with recorded discussion and learning points. In addition the practice followed local and national guidelines and best practice such as National Institute for Health and Care Excellence (NICE) guidelines.
• The service was caring. Data from the patient’s survey showed that patients rated the practice higher than others locally and nationally. For example patients spoke positively about their experiences of receiving care from their GP.
• The service was responsive. The practice was open to considering alternative methods of meeting patient’s needs and ensuring that referrals were made to hospital or other services in a timely manner.
• The service was well-led. There was a stated vision for the practice, and clear lines of accountability and leadership in place. Complaints and concerns were addressed and learning points were used by the staff to make improvements.

We saw areas of outstanding practice including:

• The practice offered in-house acupuncture by one of the GP partners as part of its approach to pain management as part of the National Health Service provided.
• The practice had developed their own risk assessment tool to identify which patients aged over 75 were most at risk of avoidable unplanned admissions. North Derbyshire clinical commissioning group (CCG) had expressed an interest in using the tool at other practices.

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

The provider should:

• The provider should have an effective system to assess the risk of, prevent, detect and control the spread of health care associated infection and ensure that any risks are identified.

• The provider should carry out a review of security at the practice and consider the risks to staff, patients, and resources.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice