Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pemberton Surgery on 22 August 2016. Overall the practice is rated as good.

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

• The practice looked after multiple vulnerable children over 100 in total. We saw good examples of the team maintaining and updating regular record checks and performing regular audits to maintain the registers.
• There were an open and transparent approach to safety and a 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 services 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.
• One member of staff was nominated and won a Kindness and Dignity Award.
• 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 did see one area of outstanding practice:

The GP partner had developed an in-house alternative to replace patients INR yellow card. INR is a test used for people using the medicines called Warfarin.

Warfarin is a medicine taken to prevent the blood from clotting and to treat blood clots. Warfarin is also used to reduce the risk of clots causing strokes or heart attacks.

The Warfarin treatment summary template was a computerised record for every patient on the medicine called Warfarin. This detailed records of past and current INR results and also included a dosing schedules, next testing dates and comment section within the template. Making the process of monitoring and prescribing Warfarin safer.

This system had been shared with the wider community where five other practices have implemented the template.

The areas where the provider should make improvements are:

• Consider having one person taking overall responsible for the infection control of the practice, whilst making sure all staff receive training.
• Develop a schedule to have full practice meetings.
• Keep reviewing, maintaining and improving the appointment system.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an inspection on 20 November 2013 and published a report setting out our judgement. We asked the provider to send us a report of the changes they would make to comply with the regulations they were not meeting.

We have followed up to make sure that the necessary changes have been made and found the provider is now meeting the regulations relating to the standards included within this report.

This report should be read in conjunction with the full inspection report.

We visited Pemberton Surgery as part of this review. We reviewed records and spoke to staff. We also asked the provider to send us information to support compliance. This confirmed that they were now meeting the regulations relating to the standards included within this report.

We spoke with seven patients and staff members. These staff members included receptionists, administrators, the practice manager, nurses and a general practitioner (GP).

The practice provided patients with information about the services available through their website.

Systems were in place to plan people's care and treatment.

We found that systems and information were in place to enable staff to report any concerns relating to children at risk. Improvements were needed in relation to safeguarding vulnerable adults’ procedures.

We saw that audits took place to enable staff to measure the quality of the service that patients receive.

Improvements were needed in relation to recruitment processes and how the service managed paper records.