This practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Requires improvement

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 Maghull Practice on 30 October 2018 as part of our inspection programme.

At this inspection we found:

• Systems were in place to manage risk and to ensure that safety incidents were less likely to happen. When safety incidents did happen, the practice learned from them and improved their processes
• The systems in place for safeguarding patients from the risk of abuse were not robust. There was no designated lead for safeguarding, safeguarding training was not up to date for all staff and a safeguarding register had only recently been produced.
• Patients told us they were treated with dignity and respect and they were complimentary about the staff team. However, a number of patients raised concerns about a lack of consistency of GPs. The only permanent member of the clinical team was the practice nurse. The provider was trying to ensure they used longer term locum GPs and they were actively trying to recruit clinical staff including GPs.
• Procedures to prevent the spread of infection were in place and regular infection control and cleanliness audits were carried out.
• Systems were in place to deal with medical emergencies and staff were trained in basic life support.
• Staff recruitment practices were carried out appropriately for all permanent members of staff.
• The provider had a system in place for gaining assurance that all required checks were in place for locum GPs contracted through an agency. However, these checks were not being carried out at this practice.
• Clinicians assessed patients’ needs and delivered care in line with current evidence based guidance for the aspects of care and treatment we looked at.
• There were systems in place for reviewing the effectiveness and appropriateness of care provided and these were being further developed.
• Data showed that outcomes for patients at this practice were similar in most areas to outcomes for patients locally and nationally. The provider was aware of the areas for improvement and was working on these.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Staff told us they felt supported in their roles and with their professional development.
• The provider learnt from complaints and made improvements to the service as a result.
• There was a clear leadership and staff structure and staff understood their roles and responsibilities.
• The provider had a clear vision to provide a safe, good quality service.
• Systems were in place to check on the quality of the service. Some of these were new and still embedding at the time of our inspection.
• There were systems in place for clinical governance and these were being further developed.

The areas where the provider must make improvements are:

• Systems in place for safeguarding patients must be improved to ensure there is a designated safeguarding lead, that all staff receive up to date training in safeguarding and that registers are reviewed on a regular basis.
• An up to date fire risk assessment must be available at the practice and fire drills must be carried out at regular intervals.

The areas where the provider should make improvements are:

• Review the newly introduced governance systems to ensure these are effective in monitoring the quality of the service provided and drive improvement.
• Review the system for monitoring patients taking high risk medicines to ensure this is consistent and fail safe.
• Continue to assess workforce requirements and recruit clinical staff.
• Ensure the system in place for gaining assurance that all required checks are in place for locum GPs is implemented.
• Provide health promotion information and advice for patients about how they can access support groups and voluntary organisations.
• Ensure all staff know how to access policies and procedures.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice