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

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

We carried out an announced comprehensive inspection at Greenbank Medical Practice on 26 June 2018 as part of our inspection programme.

At this inspection we found:

•The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

•The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

•Staff involved and treated patients with compassion, kindness, dignity and respect.

•Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

•There was a strong focus on continuous learning and improvement at all levels of the organisation.

•There was a clear leadership structure, and all staff were involved in the working of the practice. Succession planning was in place.

•The practice worked closely with a focused care practitioner who looked at the holistic needs of vulnerable patients. The impact of actions were measurable and positive.

•The nursing team held clinical support meetings to ensure they kept up to date with new guidance and were able to provide additional support to the team where needed.

We found an area of outstanding practice:

•GP appointments were available from 7.30am Monday to Friday which were particularly beneficial to working patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We first carried out an announced comprehensive inspection at Greenbank Medical Practice on 3 June 2016. The ratings for this inspection were:

Safe – Inadequate

Effective – Inadequate

Caring – Inadequate

Responsive – Requires improvement

Well led – Inadequate

The overall rating for the practice was inadequate and the practice was placed in special measures. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Greenbank Medical Practice on our website at www.cqc.org.uk.

Following the inspection on 3 June 2016 two warning notices were issued to Greenbank Medical Practice relating to dignity and respect, and good governance. We carried out a follow up inspection on 7 October 2016 and found the practice had met the requirements of the warning notice.

This most recent inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 10 February 2017. Overall the practice is now rated as good.

Our key findings 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 assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• 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 usually found it easy to make an appointment with a GP 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. The practice proactively sought feedback from staff and patients, which it acted on.

• The provider was aware of and complied with the requirements of the duty of candour.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

On 3 June 2016 we carried out a full comprehensive inspection of Greenbank Medical Practice. This resulted in two Warning Notices being issued against the provider on 12 July 2016. The Notices advised the provider that the practice was failing to meet the required standards relating to Regulation 10 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Dignity and respect, and Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Good governance.

On 7 October 2016 we undertook a focused inspection to check that the practice had met the requirements of the Warning Notices. At this inspection we found that the practice had satisfied the requirements of the Notices.

Specifically we found that:

• Chaperones were offered to patients for all intimate examinations. Use of chaperones was monitored.

• Formal interpreters were offered to all patients who did not speak English as a first language. The use of interpreters was monitored.

• Evidence of Medical Indemnity Insurance was kept for all relevant staff and a system was in place to ensure insurance and other mandatory checks were completed appropriately.

• All GPs had been tasked with completing a clinical audit. There was an audit calendar in place to monitor re-audits and all audits were discussed in clinical meetings.

• Awareness training on significant event had been provided to staff. All significant events were discussed in practice meetings and a system was in place to ensure reviews took place.

• Infection control procedures were implemented and maintained in the treatment room.

• Legionella checks took place on a monthly basis.

• The practice actively sought the views of patients via the patient participation group (PPG).

The rating awarded to the practice following our full comprehensive inspection on 3 June 2016 remains unchanged. The practice will be re-inspected in relation to their rating in the future.

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 Greenbank Medical Practice on 3 June 2016. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment and actions identified to address concerns with infection control practice had not been taken..

• Not all staff, including GP partners were clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with all relevant staff.

• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others either locally or nationally.

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

• Most patients told us they could access appointments when required, and we saw some evidence of flexibility within the appointments system.

• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

• The provider must ensure patients are treated with dignity and respect. This includes being offered a chaperone when having an intimate examination and ensuring appropriate interpreters are used so patient confidentiality is maintained.

• The provider must ensure the procedure for making complaints is brought to the attention of patients and staff. Complaints must be shared appropriately to ensure learning and people making a complaint should be advised what action they can take if they are unhappy with how their complaint has been dealt with.

• The provider must ensure there is a system in place to monitor, assess and improve the quality and safety of the service.

• The provider must actively seek the views of patients about the quality of the care and treatment they receive.

• The provider must ensure all identified risks related to the prevention and control of infection are acted on.

• The provider must ensure all appropriate employment checks are carried out prior to employing staff. There must be a system in place to ensure all GPs and nurses have up to date registration with the appropriate professional body.

• The provider must ensure all staff have received appropriate clinical and mandatory training. A record must be kept of this training and it must be monitored.

• The provider must ensure all staff have regular supervision and appraisals.

• The provider must ensure all partners have an understanding of relevant issues relating to the running of the practice.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice