Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Millbrook Medical Centre and at their branch surgery located at Tower Hill Resource Centre in Kirkby, Merseyside. This report covers our findings from both premises.

Overall the practice is rated as good.

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

• The practices are situated in purpose built premises with disabled access, translation services and a hearing loop at the main site.
• The practice was in a transitional phase of a major change in the way it delivered services to improve patient access, safety and outcomes. The practice identified issues, researched various methods and used continuous audit to monitor changes. There had been major changes to the team structure including changes to the nursing team, employment of a pharmacy team, the commissioning of a business management agency and a primary care facilitator. The practice had a business development plan which set out changes to be made and the practice also acknowledged that change processes are not always smooth. There was room for improvement in communications for staff engagement during the change process.
• There were systems in place to mitigate safety risks including analysing significant events and safeguarding. There was an emphasis on learning from significant events which drove changes within the practice.
• The practice was aware of and had systems in place to ensure compliance with the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment). The practice published its duty of candour policy on the practice website.
• Patients’ needs were assessed and care was planned and delivered in line with current legislation.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice sought patient views about improvements that could be made to the service; including having a patient participation group (PPG) and acted, where possible, on feedback.

There were elements of outstanding practice:

The practice was outstanding in terms of its approach to continuous improvement. The practice had project management plans in place for various aspects of the practice. For example, patient access and dealing with hospital letters. Projects included different phases of ascertaining the extent of any problems, researching and trying out new methods, and had evaluation systems built in to the projects. When performance didn’t meet expected standards, the practice would alter the system again and re-evaluate.

The practice had a strong learning culture and had used information from incidents to make significant changes to the practice. For example:-

• The practice realised they received on average 900 incoming letters a week to process. Following an incident whereby some important information was missed within a letter from the hospital, the systems for reviewing letters was monitored and altered. As a result the practice had a dedicated team of staff who scanned letters within 24hours and one session a day was given to a GP to read all hospital letters received and carry out any follow up actions.

• Following some medical emergencies, the practice had revised its emergency protocols and had a comprehensive emergency incident protocol and incident drill flow chart. The practice had introduced dry practice runs to ensure all staff knew what their role was. Emergency medication was centrally stored for quick access and the medication was arranged in quick grab bags with instructions on dosage/administration and use for each medication. After each incident there was a debrief session to determine if any lessons could be learned. As a result of a recent incident, the practice had purchased two oxygen cylinders to be able to respond to medical emergencies if there was a delay in paramedics attending.
• The management systems for dealing with safeguarding from reporting to monitoring and responding to requests for information had been tightened as a result of a significant event. This included having a dedicated member of staff who was responsible for the administration of any requests for information or invites to safeguarding meetings and to produce a clear audit trail of actions taken.

However, the provider should:-

• Utilise and record comments initially made by patients, who after speaking to staff no longer wished to make a verbal complaint, to use as another source of feedback to identify any trends or improvements that could be made.
• Ensure blank prescription pads for home visits are securely stored during the day.
• Look at the system for monitoring uncollected prescriptions to ensure clear accountability.
• Have a map of the building at each entrance to the premises for use by the fire services, clearly showing where oxygen is stored.
• Consider looking at improving staff engagement for any changes made to the practice.​

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with six patients who used the service, which included a member of the Patient Participation Group (PPG) during our inspection. A PPG is made up of a group of volunteer patients and practice staff who meet regularly to discuss the services on offer and how improvements can be made for the benefits of the local patient population and the practice. Everyone spoke positively about the practice and commented that they were happy with the care and treatment they had received. Some comments made were, “I would highly recommend them”, “All the staff are very understanding” and “They go the extra mile.”

The environment within the surgery was clean and tidy and the quality of the service provided was monitored on a regular basis.