Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Maghull Family Surgery on 29 June 2017. Overall the practice is 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 a system in place for reporting and recording significant events.
• The practice had systems to minimise risks to patient safety but some aspects of medicines management required improvement.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Patients said they were treated with care, 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. This included informal complaints made to the practice.
• Patients we spoke with 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.

• Staff worked well together as a team, knew their patients well and all felt supported to carry out their roles.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there were areas where the provider needed to make improvements.

The areas where the provider must make improvement are:

• Systems and processes must be in place to ensure that risks associated with high risk medicines are implemented to ensure patient safety.

The areas where the provider should make improvement are:

• The practice should develop an agreed and documented approach to the management of test results that every member of the practice team is familiar with. This should include having a system in place to track and reconcile tests requested against results received. This should be undertaken regularly to ensure there are no delays dealing with results that require prompt action.

• The system to cascade information for patient safety alerts should be reviewed to ensure all relevant alerts are reviewed and acted upon.

• Measures should be put in place to maintain the security of blank prescription forms used in printers when the printer is left unattended such as overnight or when the surgery/consulting room is not in use.

• The provider should ensurean appropriate risk assessment has been carried out to identify a list of medicines, in line with best practice, that should be in place for use in an emergency situation, both in the practice and for the purpose of home visits.

• An action plan should be implemented to address the poor results of the national GP patient survey.

• A system should be put in place to monitorpatient referrals to hospital, particularly under the two week waiting times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Maghull Family Surgery on 27 June 2017. The overall rating for the practice was good but we rated the practice as requires improvement for providing safe services. This was because the practice did not have robust arrangements in place for monitoring patients on high risk medicines. We issued a requirement notice for the provider to address this issue.

The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Maghull Family Surgery on our website at www.cqc.org.uk.

This inspection was carried out on 31 July 2018 to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breach in regulations identified in our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found that the provider had taken appropriate action to ensure an effective system was in place for monitoring patients on high risk medicines.

Our key findings were as follows:

• The provider had reviewed and updated their systems and processes to ensure that risks associated with high risk medicines were closely monitored to protect patient safety. A spreadsheet had been introduced to ensure a regular overview of patients requiring regular tests linked to the medicines they were prescribed.

We had also made a number of recommendations following our June 2017 inspection. We therefore also looked at the providers progress in addressing these. Our findings were as follows:

• The provider had reviewed the processes in place for the management of test results to ensure there are no delays dealing with results.
• A system had been put in place to monitor patient referrals to hospital under the two week wait rule.
• The system for managing patient safety alerts had been reviewed to ensure all relevant alerts were acted upon and that information on the actions taken were documented.
• Blank prescription forms were stored securely and removed from surgery/consulting rooms when not in use.
• A risk assessment has been carried out to identify a list of medicines, in line with best practice, that should be in place for use in an emergency situation.

• An action plan had been implemented to improve the service, in response to results of the national GP patient survey.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice.