Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Old Hall Surgery on 9th February 2016.

Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
• There were systems in place to reduce risks to patient safety, for example, infection control procedures and the management of staffing levels.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff felt well supported. They had access to training and development opportunities and had in general received training appropriate to their roles.

• Patients were very positive about the care they received from the practice. They commented that they were treated with respect and dignity and that staff were caring, supportive and helpful.

• Services were planned and delivered to take into account the needs of different patient groups.

• Access to the service was monitored to ensure it met the needs of patients. Patients reported satisfaction with opening hours and said they were able to get an appointment when one was needed.

• Information about how to complain was available. There was a system in place to manage complaints.

• There were systems in place to monitor and improve quality and identify risk.

We saw an area of outstanding practice:

• Two administrative staff at the practice had developed a booklet for patients over 75 which gave useful information about local health and social care services and practical advice such as how to keep healthy over winter and eating well on a budget.

The areas where the provider should make improvements are:

• Document reviews of significant event investigations to demonstrate that all action identified has been taken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Old Hall Surgery operates from a converted detached house within the Ellesmere Port area of Cheshire. There are4 practice partner General Practitioners (GP) and full supportive practice staff serving a population size of approximately 5,460 people. The practice opening hours is from 08.30 to 18.30hours and they are registered with the Care Quality Commission (CQC) to provide the regulated activities diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

Patients are very positive about their experiences at the practice and this feedback was given during our inspection. This view was also shared with us when weasked patients to complete a CQC comments cardto our visit. Patients told us that staff are caring and compassionate, friendly and helpful. Many patients have known the longstanding GP’s for many years and they told us they are confident their family’s needs are consistently met by the practice. Three of the 27 patients comments cards reported that appointments are at times difficult to access.

The practice has a strong culture of patient safety and awareness. They have a good leadership team who encourage all staff to be proactive in engaging with patients, learning from incidents and taking ownership when things do not go as planned and incidents occur.

The practice is providing an effective service for their local population. Care and treatment is considered in line with current published guidelines and best practice all of which are available to staff on their intranet.

Throughout our inspection we saw good compassionate care where patients are given time and support during their appointment. We saw how the whole team were responding to both the clinical and non-clinical needs of their patients. We found the practice to be a responsive practice in particular in terms of patient access and in listening to patient feedback. Each of the population groups we reviewed during the inspection were receiving a good service from the practice.

We carried out an announced comprehensive inspection at Old Hall Surgery on 22 January 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We rated the practice as requires improvement for providing safe services because:

• There were shortfalls in the required information to demonstrate staff were suitable for employment.
• The practice was not able to show all clinical staff had completed fire safety, adult safeguarding, information governance and infection control training.

We rated the practice as good for providing effective, caring, responsive and well-led services.

We found that:

• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice monitored patient access to services. There had been a number of changes to the clinicians at the practice but a plan was in place to address this by providing greater continuity.
• The practice organised and delivered services to meet the needs of patients.
• There was a system in place for investigating and responding to patient feedback including complaints.
• There was a focus on continuous learning and improvement at all levels of the organisation.

We saw an area of outstanding practice:

Two administrative staff at the practice had developed and kept updated a booklet for patients over 75 which gave useful information about local health and social care services and practical advice such as how to keep healthy over winter and eating well on a budget.

The area where the provider must make improvements are:

• Systems and processes must be in place to ensure specified information is available regarding each person employed and to demonstrate that all staff have received training suitable for their role.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• The security of patient records should be reviewed to protect from risk of damage and inappropriate access.
• Formalise the system for reviewing the practise of clinical staff to ensure consultations, referrals and prescribing are appropriate.
• Evidence of physical and mental suitability of staff for their role to be formally recorded
• Review the safety of prescriptions left in printers overnight or when the clinical rooms are not in use.
• Review the system for ensuring medication reviews are carried out in a timely manner and continue to monitor adherence to the revised procedure.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice