Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 28/06/2016 – Good)

The key questions are rated as:

Are services safe? – Good

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 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 Ormskirk Medical Practice on 13th December 2017 as part of our inspection programme to inspect 10% of practices before April 2018 that were rated Good in our previous inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. 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. Care and treatment was delivered according to evidence- based guidelines.We saw that clinical audit was carried out.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Some patients found it difficult to use the system to book routine appointments however patients reported that they were able to access care when they needed it.

• There was evidence that innovation and service improvement was a priority among staff and leaders.

The areas where the provider should make improvements are:

Embed the protocol for management of DMARDs (disease-modifying anti rheumatic drugs used for the treatment of rheumatoid arthritis).

Fully document staff appraisals.

Continue to review access to routine appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ormskirk Medical Practice (known previously as Leyland House Surgery). Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe, effective, and well led services. However it was rated as good for providing a caring and responsive service.

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

• Most staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and managed, with the exception of those relating to recruitment checks.
• Data showed patient outcomes were below average for the locality and the practice was taking action to address this, although this was not formalised into an action plan.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice proactively sought feedback from patients and complaints were investigated and responded to appropriately.
• Urgent appointments were usually available on the day they were requested. However patients said that trying to get through on the telephone to the practice was challenging.
• The practice had a number of policies and procedures to govern activity. Many of these had been recently reviewed and updated but several still required updating.
• There was lack of clarity about the leadership of the practice and the staff did not know what the vision and strategy was for the practice.

However there are areas where the provider must make improvements:

• Ensure recruitment processes are up to date and include all necessary employment checks for all staff.

• Ensure induction training for all staff is comprehensive and prepares each staff member to undertake their role and responsibilities safely and effectively.
• Ensure there is a clear management and organisational structure that includes a lead for clinical governance and ensure formal governance arrangements are in place, to assist in monitoring and addressing gaps in performance.

In addition the provider should:

• Develop a practice vision and strategy that is shared with all staff, to ensure there is a collective understanding of what the practice wants to achieve and how each team member can contribute to the vision.
• Ensure GPs have appropriate updated training to allow them to effectively use the electronic patient record system.
• Ensure a system to monitor stocks and expiry dates of medicines for use in emergencies that are held in GP’s bags is implemented so that medicines are available and are replaced in a timely manner.
• Improve the administration and organisation of both paper and electronic records, such as policies, procedures and risk assessment so that all staff can access these quickly
• Ensure information on the practice website is up to date and includes details of how to book online appointments.
• Display fire procedure for patients in waiting rooms, especially in the first floor waiting rooms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We visited the surgery on 13th September 2013 and spoke to the practice manager and general practitioner, staff and patients. We looked at outcomes 1, 4, 7, 12 and 16. During our inspection we assessed standards relating to respecting and involving people, care and welfare, safeguarding people from abuse and how people were supported to be involved in their care. Standards relating to staff recruitment and monitoring the quality of service provision were also inspected. We did not identify any concerns in any of the outcome areas we assessed.

We were able to speak with seven people who used the service (patients). They confirmed that all of the staff always explained what they were going to do. One patient we spoke with told us that, "This is a practice where the staff care and the compassion and respect is always there”. Another told us, “I may moan about the appointments but never about the doctors, they listen and talk to you, not at you”.

All of the patients we spoke with confirmed that they felt confident that their doctor understood their condition. One patient told us, "Dr…. tracked me down after I moved address as I had a malignant melanoma. He didn’t just give up”.

The practice participates in the Quality and Outcomes Framework (QOF), a system used to monitor the quality of services in GP practices. However a programme of systematic audits would show how the practice monitored the quality and effectiveness of services provided to its patients.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive follow up inspection at Ormskirk Medical Practice (also known as Leyland House Surgery) on 28th June 2016. This was undertaken following an inspection on 6 May 2015 when requirement notices were issued. This was due to shortfalls identified in recruitment processes, staff training and support as well as the governance of the practice.

We found at the June 2016 visit that improvements had been made. Overall the practice is now 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 an effective system in place for reporting and recording significant events.

• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about the services provided and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• Ward rounds had been introduced at a local nursing home where there had been high rates of hospital admissions, attendance at Accident and Emergency and usage of the Out Of Hours GP service. Following this initiative all of these outcomes had been significantly improved and the approach was about to be rolled out to other nursing homes

The areas where the provider should make improvement are:

• Continue to identify carers registered at the practice and ensure they receive appropriate care and support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice