At the previous inspection of Firdale Medical Centre on 30 June 2015 the practice was rated as outstanding for providing responsive and well-led services and an overall rating of outstanding was given.

We carried out this announced comprehensive inspection at Firdale Medical Centre on 12 March 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for population groups in the effective domain.

We have rated this practice and the population groups as requires improvement for providing responsive services because:

• The National GP Patient Survey indicated that patient satisfaction was below the England average for getting through to the practice by telephone and below the CCG and England averages for experience of making an appointment and satisfaction with opening times. The provider had not taken action to demonstrate that patient satisfaction with access had improved.

We rated the practice as good for providing safe, effective, caring and well-led services.

We found that:

• There were clear systems and processes in place to ensure appropriate standards of hygiene and cleanliness were met and that the premises and equipment were safe.
• Staff knew how to report safety incidents and they were confident they would be acted upon.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff were provided with the training and support required for their roles.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice monitored patient access to services. They adjusted access to ensure that it met the needs of patients.
• The practice organised and delivered services to meet the needs of patients.
• There was a system in place for investigating and responding to patient feedback.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The area where the provider must make improvements are:

• Ensure that patients’ experiences of accessing services are monitored to make sure that improvements have been made.

The areas where the provider should make improvements are:

• Continue to ensure staff have the information they need about safeguarding concerns when booking appointments for patients.
• Monitor the revised procedures for the management of uncollected prescriptions and the security of prescriptions.
• Record all significant events on one record to enable patterns and trends and progress to be more easily identified.
• Put in place a spreadsheet to monitor safety alerts.
• Information about support groups to be made available on the practice website.
• The remit for referrals to the self-employed counsellors to be documented.
• A written agreement between the counsellor, practice and patient to clearly identify what information is to be recorded, where it is to be stored and who has access to this information.
• Ensure there is an effective system for managing verbal complaints.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

This is the report from our inspection of Firdale Medical Practice. We undertook a planned, comprehensive inspection of the practice on the 30 June 2015.

Overall the practice is rated as outstanding.

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

• There were systems in place to mitigate safety risks including analysing significant events and safeguarding. Systems were in place to ensure medication including vaccines were appropriately stored and in date. The practice was clean and followed best practice guidelines for infection control.

• Patients had their needs assessed in line with current guidance and specific clinics were set up in response to guidance.

• The practice accommodated other visiting healthcare professionals and advisory groups and had an ECG (heart monitoring) machine so that patients did not have to be referred elsewhere.

• Feedback from patients and observations throughout our inspection highlighted the staff were kind, caring and helpful.

• Staff were highly skilled and worked well as a team.

There were outstanding areas of practice including:-

• A practice ethos of focusing on the patient journey. The practice was one of only 45 practices in the country to win the Royal College of GPs Quality Practice Award twice (the highest award attainable) and had recently won three Carers awards.

• Systems in place to prevent child medical emergencies. For example, during the winter months the practice had review appointment times later in the day for acutely unwell children who had been seen in the morning so that the GP could monitor the child’s progress, reassure the parent/guardian and reduce the likelihood of hospital admission.

• All members of staff had been trained to recognise early warning signs of domestic abuse and this had resulted in cases being identified.

• Maximising use of IT systems for example, using a ‘patient chase’ software system had resulted in reducing time spent recalling patients for reviews. IT systems were used to organise documentation that underpinned the governance structures in place. All policies were practice specific and had input from staff and were constantly reviewed with a designated member of staff responsible for each policy which were reviewed at clinical meetings.

• Maximising the use of communication systems between staff to ensure patient welfare. For example, daily referral meetings held for all the GPs reviewing cases to provide peer support, in addition to weekly clinical meetings and regular whole team meetings.

• A strong learning and staff empowerment culture. For example, clinicians shared their personal summary of appraisals and personal development plans to generate the way forward for practice learning.
• Staff were empowered to be part of the continuous improvement processes of the practice and were involved in discussions about how to run the practice and how to develop the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice