We carried out an announced comprehensive inspection at Rishton and Great Harwood Surgery on 29 April 2019. This was the first inspection of this GP practice under this registered provider. As part of this inspection we visited both the practice at Rishton and the branch surgery at Great Harwood.

The single-handed GP completed the registration of the service with the CQC in November 2018. The GP confirmed due to other issues overall management and leadership of the service did not occur fully until March 2019.

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 requires improvement overall.

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

• Some systems and processes to keep patients safe required improvement.
• Reception staff had not been given clear guidance on identifying deteriorating or acutely unwell patients. There was lack of clarity regarding the actions to take in respect of such patients.
• Systems to recognise opportunities to learn and make improvements when things went wrong were not in place.

We rated the practice as requires improvement for providing well-led services because:

• A practice business development plan with an action plan was not available. A copy was provided after the inspection.
• Governance arrangements to monitor and review the service provided were not fully established.
• Clear and effective processes for managing risks, issues and performance required improvement.
• Systems to ensure patient information was reviewed and recorded accurately were not established.

We rated the population groups as good except for Families, children and young people which we rated as requires improvement.

• Children who did not attend appointments were not followed up.

We rated the practice as good for providing effective, caring and responsive services because:

• Patients received effective care and treatment that met their needs.

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

The areas where the provider should make improvements are:

• Provide training to the practice cleaner.
• Undertake infection control audits and monitoring at both surgeries.
• Implement best practice guidance and obtain written consent before undertaking minor surgery.
• Undertake a data cleanse of the carer’s register to validate its content as accurate.
• Continue to promote and develop the patient participation group.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care