Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Dr Munro and Partners on 4 November 2014. We found that the practice was performing at a level which led to a ratings judgement of Good.

Our key findings were as follows:

• The practice was safe, staff reported incidents and learning took place. The practice had enough staff to deliver the service.

• The practice was effective. Services were delivered using evidence based practice.

• The premises were clean and fit for purpose and equipment was available for staff to undertake their duties.

• Staff were caring and compassionate, treated patients with kindness and respect and we saw good examples of care.

• The practice was responsive to the needs of patients and took into account any comments, concerns or complaints to improve the practice.

• The practice was well led, with an accessible and visible management team, governance systems and processes are in place and there was performance and quality management information available. Quality was high on the practice agenda.

We saw several areas of outstanding practice including:

• Working in co-operation with another organisation to identify patients that were 65 or over and vulnerable to reduce the risk of fire in their homes. Patients from this practice had the highest take up of this scheme in Wigan Borough.

• The adopted apprentice scheme for administration staff that had been in place since 2008 and has resulted in 100% employment for those on the scheme. One apprentice had progressed to a supervisory role.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Outstanding overall. (Previous rating October 2014 – Good)

The key questions at this inspection are rated as:

Are services safe? – Outstanding

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Outstanding

At this inspection we found:

• There was an open culture in which all safety concerns raised by staff and people who used the service were highly valued and integrated into learning with improvements made. Some of these learnings were shared with peers and local Clinical Commissioning Groups (CCG).

• Throughout our inspection there was a strong theme of bespoke education and training programmes which had been developed to maintain safe processes and align with the practice’s in-house processes, being a clear link between a clinical need and the training delivered. These were overseen and maintained by all the clinical staff.

• The practice had a clear vision which had holistic care, quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with all staff.

• The practice had clearly defined and bespoke embedded systems, processes and practices in place to keep staff and patients safe.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines at their practice educational meetings.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

• The practice had identified a high number of carers and one of these was also documented as a child carer.

• The practice had a highly active Patient Participation Group (PPG), who ran various carer groups for patients and local community,

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

We saw several areas of outstanding practice:

• One significant incident involved a violent and threating patient, which saw the practice being locked down until the police arrived. Part of the practice system for analysing significant event, it was identified the need for a lock down policy and learning was identified. The practice fitted CCTV and a panic alarm connected to the police. The practice manager worked closely with the CCG and other practice managers who set up a working group to develop a policy for locking down a practice, shared and rolled out to all practices in the Borough.

• We saw 100% of patients at end of life having had a preferred place of death recorded. Where Do not attempt cardio-pulmonary resuscitation (DNACPR) orders were in place we saw patients had been involved in and agreed with this decision. The practice had also audited if they had achieved the patient’s wishes and identified these wishes had been achieved 71%. The practice also designed an End of life grab bag for clinicians.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.