This practice is rated as Good overall. (Previous inspection March 2017 – Good)

We carried out an announced comprehensive inspection on at Gorton Medical Centre on 27 March 2017. The overall rating for the practice was good with key question Well Led rated as requires improvement. At that inspection we found improvements were needed in the practice systems for the monitoring of incidents and significant events, and where learning and improvement were identified these were not always shared effectively. We issued a requirement notice in respect of good governance, as further improvements were required We identified other areas of improvement including undertaking full cycle clinical audits and monitoring and sharing patient safety alerts as part of the practice’s quality improvement programme and listening to patient feedback, developing the patient participation group and maintaining a carer’s register.

The full comprehensive report on the March 2017 inspection can be found by selecting the ‘all reports’ link for Gorton Medical Centre on our website at www.cqc.org.uk

This inspection was a focused visit to the practice on 4 April 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 27 March 2017. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

This focused inspection visit identified improvements had been made in service delivery for key question Well Led and this is now rated good.

Our key findings were as follows:

•At our previous inspection in March 2017 we found some records of significant event investigations did not contain all the required information and evidence that the findings from investigations was shared with staff was limited. At this inspection visit, both practice full team meeting and clinical meeting minutes showed the significant events were discussed and evidence was available to demonstrate improvements were made and learning from these was shared.

•Since the previous inspection, the practice had reviewed how it ensured patient safety alerts were shared with the staff team and had introduced a system to ensure these were acted upon as required.

•The practice had introduced a range of clinical searches on a variety of patient health care conditions. These searches were allocated to GPs who undertook relevant clinical audit and re-audit to evaluate the effectiveness of the actions the practice had implemented to improve patient outcomes.

•The practice had introduced a carer’s information pack and referral process. It had made some headway in building a carer’s register. However there were still low numbers of patients’ identified as carer’s.

•The practice had implemented a patient survey and initial results had indicated patients were satisfied with the service. The practice manager had identified areas requiring action as a result of patient feedback.

•The practice continued to promote their patient participation group and held regular practice meetings

The areas where the provider should make improvements are:

Continue to develop the practice carer’s register and the patient participation group.

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 Gorton Medical Centre, 46 Wellington Street, Gorton, Manchester, M18 8LJ on 11 February 2016. During that inspection we identified breaches of regulation 12 (Safe Care and Treatment), regulation 17 (Good governance) and regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The breaches resulted in the practice being rated as requires improvement for being safe, effective, responsive and well-led and good for being caring. Consequently the practice was rated as requires improvement overall. The full comprehensive report on the 11 February 2016 inspection can be found by selecting the ‘all reports’ link for Gorton Medical Centre on our website at www.cqc.org.uk.

At this announced comprehensive inspection on 27 March 2017 we checked whether improvements had been made since our inspection in February 2016.

We found improvements had been made in respect of;

Safe

• Risk assessments had been carried out since the last inspection out and were kept under review.

Effective

• Appropriate recruitment checks were carried out including disclosure and barring service (DBS) checks had been obtained.

• Staff appraisals had been carried out in the past 12 months, personal development plans and a training matrix were in place.

Well-led

• Policies and procedures had been reviewed and updated since the inspection in February 2016.

At this inspection carried out on 27 March 2017

Our key findings were as follows:

• A new practice manager had been appointed in June 2016.

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, there was no comprehensive system in place to demonstrate learning from significant events to prevent the same things happening again.

• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• The practice policies and procedures had been reviewed within the last 12 months, these were in line with current guidance and available to staff.

• Staff were aware of current evidence based guidance. Staff had access to an on-line training programme to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients we spoke with said they generally found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. However, some patients did report difficulties booking appointments by telephone.

• 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. Each GP and senior member of staff had defined clinical responsibilities in different areas such as child protection and adult safeguarding, elderly care and information governance.

• The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw one area of outstanding practice:

The practice was participating in the nursing home project to provide a proactive, preventative service for patients residing in residential and nursing homes. A nominated lead GP from the practice visited a local care home twice a week. This level of support aimed to reduce the use of out of hour’s services and reduce unnecessary accident and emergency (A&E) attendances.

However, there was one area of practice where the provider needs to make improvements.

• Ensure there is a clear process for the monitoring of and learning and improving from incidents and significant events. Also, that staff are made aware of the decisions made and changes in practice required as a result of discussions about incidents and significant events.

The areas where the provider should make improvement are:

• The provider should continue with their efforts to develop a patient participation group (PPG).

• Ensure the practice have a planned and structured approach to identifying and carrying out a programme of improvement. Ensure full cycle audits are completed with review dates and use clinical audits to benchmark the quality of the clinical care being provided and to demonstrate sustained improvements.

• Review the system in place for the dissemination and monitoring of patient safety alerts to demonstrate that action had been taken relevant to the alert, after they were disseminated within the practice.

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is available to them.

• Consider what action needs to be taken to improve areas of lower patient satisfaction results from surveys with the service.

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 on 11 February 2016 at Gorton Medical Centre. Overall the practice is rated as requiring improvement. Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were not always assessed appropriately. For example, risks in relation to lone working, carrying blood samples and health and safety risks.
• Each GP and senior member of staff had defined clinical responsibilities in different areas such as safeguarding, elderly care and information governance.
• There was no system to monitor and audit the traceability of the prescription paper used in the practice.
• The recruitment arrangements did not include all necessary employment checks for all staff employed by the practice. This includes the need for a Disclosure and Baring Service (DBS) check when appropriate.
• 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.
• The practice was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The policies were not consistent with current guidance and staff did not always have access to all relevant policies and procedures.

Areas of outstanding practice:

• The practice was working to actively support and mange people living in care and nursing homes to avoid unplanned admissions into hospital. A lead GP conducted a ward round type visit in the local care home.

The areas where the provider Must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff employed by the practice. This includes the need for a Disclosure and Baring Service (DBS) check when appropriate, such as when staff engaged in 1:1 contact with patients.
• staff are acting as chaperones. This includes checks and records for locum GPs.
• Ensure that all staff are provided with the relevant induction and training to carry out their role and responsibilities, for example, safeguarding training.
• Ensure all staff receive supervision and appraisal within appropriate timescales and all staff files are monitored regularly.
• Ensure there is a system to monitor and audit the traceability of the prescription paper used in the practice.
• Ensure the premises are risk assessed to ensure they are sufficient to meet the needs of the patients, especially around compliance with the disability discrimination act (DDA).

The areas where the provider should make improvements are:

• Review and update policies to ensure that practice is consistent with current guidance and ensure all staff have access to all relevant policies and procedures.
• Staff should have access to job descriptions to ensure they are aware of the roles and responsibilities they have.
• More routine staff meetings should be available and any learning should be shared with all staff groups.
• Respond to feedback sought from all sources including the national GP patient survey and information from the NHS Choices website.
• Ensure the practice business strategy is up to date and fit for purpose.
• Assign a lead person for the QOF data and for other performance measures.
• Conduct annual infection control audits.
• Ensure a thorough review of risks is undertaken with appropriate mitigating actions. For example, risks in relation to lone working, carrying blood samples and health and safety risks.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We talked with four patients who attended Gorton Medical Centre on the day of our inspection. One patient said: "I can't fault them at all. I wouldn't change the doctors. The receptionists are great too." Another person said: "The staff are friendly, this is one of the better surgeries in the area." One patient said that when they had needed an emergency appointment they had been given one within an hour.

We found that the practice respected patients' wishes although some patients said the appointment system was not ideal. We found that staff were well trained in safeguarding issues and knew how to report any suspicion of abuse.

We found that the practice made good use of the available space, and that the premises were well maintained.

We found there were good systems for recruiting staff. The practice discussed issues affecting patient care internally, although there was more they could do to encourage patient feedback.

The practice dealt with complaints efficiently.