This practice is rated as Requires improvement overall. (Previous rating 17/03/2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at St Chads Medical Practice on 15 March 2019. As part of our inspection programme. At the last inspection in March 2015 we rated the practice as good in all domains.

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

• At the time of the inspection there was no system to check the on-going registration of all clinicians and evidence of current medical indemnity insurance was not available for all locum GPs.
• There had been no practice health and safety risk assessment.
• The system for checking the defibrillator and oxygen needed to be improved.
• Some medical equipment was beyond its expiry date.
• Not all the expected emergency medicines were held and there had been no risk assessment.
• There was no system to check patients who had been referred under the two-week wait system had attended their appointment.
• Significant events were not routinely reviewed.

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

• Some abnormal tests results had not been actioned.
• There were below average QOF figures for some clinical data including for diabetes and chronic obstructive pulmonary disease (COPD).
• The practice did not have a programme of clinical audits.
• Training was not always updated at the appropriate time and the practice did not hold a record of all staff training. For example, the infection control policy stated training would be updated annually but this did not occur.

We rated the practice as good for providing caring services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.

We rated the practice as good for providing responsive services because:

• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

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

• There was some evidence of risk assessment but there were gaps in health and safety and emergency medicines.
• Although policies were in place these were in the name of the partners’ other practice, who they worked closely with.
• There was little evidence of systems and processes for learning and continuous improvement.
• There was no programme of clinical audits.
• There was not always formal support and assessment of staff.

These areas where improvements were required affected all population groups so we rated all population groups as requires improvement.

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.

The areas where the provider should make improvements are:

• Look to identify more patients who are carers so appropriate support can be offered.
• Review the process for managing significant events so SEAs are reviewed and learning implemented.
• Look at the virtual patient participation group (PPG) as a way for obtaining the views of patients.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Chads Medical Practice on 17 March 2015

Overall the practice is rated as good. We found the practice provided safe, well-led, effective, caring and responsive services.

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. All opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information was provided to help patients understand the care available to them.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
• The practice had a vision which was patient focussed. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We also saw areas of outstanding practice:

• The practice had implemented frailty assessments for elderly patients.
• The practice had invested in their health care assistant (HCA) training and had given them the opportunity to enhance their role beyond usual boundaries. The HCA visited the elderly in their own home to assist in reducing the isolation of housebound patients and making sure their medicines are up to date.
• All new patients to the practice under the age of 5 years were discussed with the health visitor and school nurse to ascertain if they were known to services to allow the practice to support the patients fully.
• The practice had direct access to the electronic system used by their Out of Hours service which allowed them to add any changes to patient’s conditions as they happened.

However there were areas where the provider should:

• Ensure the first aider has updated training in the near future.
• Ensure their clinical staff have access to appropriate uniforms for their roles.
• Ensure senior non clinical staff have access to mentorship to allow them to effectively fulfil their roles.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice