This practice is rated as Good for providing safe services. (Previous rating December 2017 – Good overall and requires improvement for safe).

The key question at this inspection is rated as:

Are services safe? – Good

We carried out an announced focused inspection at Magnolia House on 8 August 2018. We undertook this inspection to follow up on breaches of regulations following the previous inspection in November 2017. We inspected areas of the safe domain as part of this inspection.

At this inspection we found:

• The provider had initiated a comprehensive log of patient safety and medicines alerts received into the practice and ensured action was taken.
• A risk assessment for one of the smaller clinical rooms had been carried out and a list of suitable procedures and assessments that could take place in the room was available to all staff.
• The practice had reviewed the prescribing guidance and had reviewed their protocols for patient group directions and patient specific directions.
• The practice had commenced formal recording of the health status of employees to ensure they could offer reasonable adjustments where appropriate.

As part of this inspection we also followed up on previous concerns relating to practice compliance with the accessible information standard (AIS). We found the practice had not considered the communication needs of patients at the last inspection. During this inspection we found the practice had implemented an AIS policy in January 2018 and adopted an AIS toolkit. Staff were offered training and the reception team had printed AIS reminders for use at the reception desk. The patient new registration form included questions to identify any communication needs of patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection October 2014 – Good)

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

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Magnolia House on 8 November 2017. This inspection was carried out as part of our new phase of inspections, which commenced on 1 November 2017. The practice had previously been inspected in October 2014 and was rated as good overall and requires improvement for safe.

Our key findings were:

• The practice had systems in place to manage risk. However, these were not always consistently applied and we found concerns with patient group directions and patient specific directions, patient safety alerts processes and staff recruitment files.
• 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.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Ensure staff health needs are identified, reviewed and recorded so reasonable adjustments can be made, where necessary.
• Consider patient communication needs in regard to the accessible information standard.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

At this inspection we checked to see if improvements were made to recruitment procedures following our last inspection on 23 April 2014. We looked at management and staff records. We did not need to speak with patients as part of this review.

Since our last inspection improvements were made to the practice's procedures for recruiting staff. We saw staff files contained information and background checks required under the regulations for staff working in health and social care.

During our last inspection in November 2013 we found the provider was not meeting essential standards of quality and safety. We asked the provider to report on what action they would take to meet compliance with the standards. At this inspection we checked to see whether improvements had been made. We spoke with the practice manager, nurses, a GP (who was a partner at the practice) and other clinicians. We did not need to speak with patients during this inspection.

Since our last inspection the provider had implemented new systems to monitor the quality of the service they delivered. We saw a training tool which assisted the manager to identify staff training needs. A hygiene and infection control audit had been introduced. We saw the audit had led to information posters being put up for staff to follow.

The practice was not undertaking appropriate checks when we visited in November 2013. At this inspection we found appropriate background checks were taking place. However, not all information required under the regulations was available in regards to the recruitment of staff.

Safeguarding vulnerable adults and children training was provided to staff. The provider ensured staff were aware of where to find information if they had concerns about patient safety or the conduct of other staff.

During our inspection we spoke with eight patients, a receptionist, the lead nurse, the practice manager, the registered manager and two other GPs, who were partners in the practice. Patients told us they were satisfied with the care and treatment they received. Patients said they were usually able to access appointments. The surgery had recently implemented a new appointment booking system as a result of patient feedback.

The practice provided various clinics and services such as family planning, screening for specific conditions and minor surgery. The service had specialists in the treatment and management of various conditions. This enabled staff to refer patients to appropriate staff internally. The service supported patients with long term conditions appropriately.

Staff were provided with some awareness in safeguarding. However staff were not provided with training in safeguarding vulnerable adults. There was no whistleblowing policy for staff to refer to.

The service's recruitment procedure did not account for all background checks and information required under the regulation.

The practice undertook robust monitoring on its clinical outcomes, and communicated well with patients and staff to improve standards of care. Significant events were reviewed to ensure appropriate learning and action was taken. Some management of the service, such as staff training was not monitored effectively.

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Magnolia House general practice on 22 October 2014. We have rated the overall practice as good. We found the safe domain was rated as requires improvement and the effective, caring, responsive and well led domains were rated as good.

Our key findings were as follows:

The practice is rated as requires improvement for safety. We found one of the treatment rooms did not have appropriate facilities. There was no risk assessment in place on the potential risks this treatment room placed on patients and how these risks were to be managed. Systems were in place for reporting and responding to safety incidents and alerts. The practice had a system in place for reporting, recording and monitoring significant events.

Generally the feedback from patients was very positive. Patient were complimentary of all the staff and described them has friendly, respectful, caring and thoughtful. Patients were very happy with the service they received.

We found the service was responsive to patient’s needs. Patients we spoke with were generally happy with the appointment system. The national GP patient survey 2013 showed 84% of patients said they were able to get an appointment when they last tried. Eighty seven per cent patients described their overall experience of the practice as good. Overall 79% of patients said they would recommend the practice to someone new to the area.

Patients’ needs were assessed and care and was planned and delivered in line with current legislation. Staff had received training appropriate to their roles and further training needs had been identified and planned. The practice was well led, and had a clear vision and strategy. The practice had a clear leadership structure and staff we spoke with felt supported and valued.

The practice is a GP training practice.

There were areas of the practice where the provider needs to make improvements

The practice MUST

• Ensure all treatment rooms have appropriate facilities to ensure safe delivery of care. Carry out a risk assessment for one of the treatment rooms to ensure it is fit for purpose.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice