Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Huntley Mount Medical Practice on 19 May 2016. The overall rating for the practice was requires improvement. The practice did not have effective systems in place to assess the risk of and to prevent, detect and control the spread of health care associated infection. Thorough recruitment and selection procedures were not in place and there was no clear system for the recall of patients with long term conditions and those who did not attend their follow-up appointments. Within an agreed timescale the practice submitted an action plan which demonstrated they are now meeting the requirement notices from this inspection. The full comprehensive report on 19 May 2016 inspection can be found by selecting the ‘all reports’ link for Huntley Mount Medical Practice on our website at www.cqc.org.uk.

We carried out this announced comprehensive inspection at Huntley Mount Medical Practice on 24 January 2017. Overall the practice is now rated as good.

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 assessed and well managed.

• Thorough recruitment and selection procedures were in place.

• There was a clear system for the recall of patients with long term conditions and those who did not attend their follow-up appointments.

• There was an infection control protocol in place and staff had received up to date training. Annual infection control audits were undertaken.

• 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. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients said they found it easy to make an appointment with a named 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.
• There was an innovative approach to the practice child nasal flu campaign.Flyers sent to all local schools and nurseries with relevant aged children in September 2016. Letters were also sent to all parents promoting nasal flu vaccination. Discussions were held with the head teacher of one school and letters were sent out to all head teachers promoting the benefit of nasal flu vaccination.

Area of outstanding practice:

• The practice staff organised a dementia awareness day 

  working in consultation with national charities and local hospital consultants. This day was 

  open to all Bury patients.Staff were also arranging a crown green bowling event in the park opposite surgery with Bury Council funding; this was planned for Summer 2017.

The areas where the provider should make improvement are:

• A detailed analysis of significant events should take place with detailed records kept of the findings and actions taken to address any changes to practice.

• A record should be kept of meetings held for the purpose of monitoring issues discussed.

• More detailed information needs to be recorded in clinical audits and a plan should be drawn up for the completion of future audits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Huntley Medical Practice was inspected on 19 May 2015. This was a comprehensive inspection. This means we reviewed the provider in relation to the five key questions leading to a rating on each on a four point rating scale. We rated the practice as good in respect of being caring and well led, and requiring improvement in relation to being safe, effective and responsive. This gives the practice an overall rating of requires improvement.

Our key findings were as follows:

The practice has systems in place for reporting, recording and monitoring significant events. Significant incidents and events are used as an opportunity for learning and improving the safety of patients, staff and other visitors to the practice.

Patients we spoke with told us that they were communicated with appropriately by staff and were involved in making decisions about their care and treatment. They also said that they were provided with enough information to make a choice and gave informed consent to treatment.

Information we received from patients reflected that practice staff interacted with them in a positive and empathetic way. They told us that they were treated with respect, always in a polite manner and as an individual.

Patients at the practice could also access urgent and routine GP appointments via extended hours arrangements at Moorgate Primary Care Centre in Bury seven days a week Monday to Friday between 6pm and 8pm (and between 8am and 6pm weekends and bank holidays).

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

Importantly, the provider must:

There was no evidence that a risk assessment had been carried in respect of the potential risk from legionella contamination. Legionella is a germ found in the environment which can contaminate water systems in buildings. The provider must take action to ensure the effective operation of systems designed to assess the risk of and to prevent, detect and control the spread of health care associated infection.

The provider must improve the system of staff recruitment to ensure that patients are protected by operating effective recruitment and selection procedures that includes relevant checks being carried out (and evidenced) when staff are employed or are engaged in a role where such checks are required.

A system was in place to provide health assessments and regular health checks for patients when abnormalities or long term health conditions are identified. However there was no clear system for recall of patients to attend health reviews and assessments of long term conditions (including those with a learning disability or a mental illness) or for following up on patients who did not attend reviews and assessments. The provider must take action to ensure suitable systems are in place to effectively recall patients to attend health reviews and assessments and to follow up people who do not attend.

In addition the provider should:

The electronic patient records system did not alert the GPs and other clinical staff when a safeguarding issue or safeguarding plan had been identified and developed for child or adult patients. Whilst this information was in the patients record to maximise the awareness of clinical staff (particularly locum staff) the records alert system should reflect where safeguarding issues or a safeguarding plan have been identified or developed.

We saw evidence that checks (audits) had been undertaken to make sure measures taken to prevent the spread of potential infections were periodically risk assessed. However the last record we saw relating to these checks was dated September 2012. To ensure their continued effectiveness and minimise the risks associated with potential infections the provider should conduct such checks more frequently.

We were informed the practice manager who was also the practice nurse had very recently left the practice. This clearly posed significant potential risks for the clinical and management arrangements within the practice. We asked how the potential risks associated with this situation were being managed. The principal GP informed us that a recruitment process had commenced to fill these key roles as soon as possible. We were also informed that in the interim the clinical support that would have been the responsibility of the practice nurse was being provided by the two GPs. However as the principal GP is full time and the locum GP is part time (with their own considerable workload) the risk associated with the lack of a practice nurse is significantly increased for the 3,030 patients registered at the practice. Also in the interim the managerial role of the practice manager was being fulfilled by the assistant practice manager supported by the principal GP. We also noted that staffing provision supporting the reception and phlebotomy functions of the practice had been subject to significant disruption over recent months. Whilst we acknowledge action had been taken to address staffing disruption the provider should continue to ensure staffing levels and skill mix are planned, implemented and reviewed to keep people safe at all times.

We were informed by the principal GP that the decision had been taken not to have an automated external defibrillator or nebuliser as part of the resuscitation equipment used at the practice. The provider should review this decision following consideration of current guidance and national standards that reflects that practices should have particular resuscitation equipment.

We noted formal minuted practice meetings were infrequent. Whilst we acknowledge the practice is relatively small and there were good informal systems of communication between staff, action should be taken to demonstrate that the implications of new guidelines and ways to improve the quality of the services provided are regularly discussed with staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We reviewed the information available to us about Huntley Mount Medical Centre on 17 April 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.