This practice is rated as Good overall. (Previous rating March 2018 – Good)

The key questions at this inspection are rated as:

Are services well-led? - Good

We carried out a focused desk-based review of The Euxton Medical Centre on 25 September 2018. This inspection was to see whether the breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance) found at our last inspection had been addressed. For this inspection, we focused on the key question of Well-led which we rated as requires improvement in March 2018.

At this inspection we found evidence the breach had been addressed; specifically, we found:

• Practice policies and procedures had been reviewed and implemented where necessary to support the delivery of safe and effective services.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. Lessons learned from patient complaints and significant incidents were discussed and shared with all staff.
• Management overview of actions taken as a result of patient safety alerts had been improved.
• The governance of clinical staff training and membership of professional bodies had been strengthened.
• The practice had introduced and embedded a new system to ensure the security of prescriptions in the practice.

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.

This practice is rated as Good overall. (Previous inspection 5 August 2015 – 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? – Requires Improvement

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 recently 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 Euxton Medical Centre on 1 March 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured care and treatment was delivered according to evidence- based guidelines. There was a comprehensive quality improvement programme in place.
• The practice had systems to manage risk so safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes although action taken as a result of incidents was not reviewed to ensure effectiveness.
• Practice governance systems required improvement. There was a lack of oversight of actions taken in respect of patient safety alerts and professional indemnity. The practice policies for dealing with communications into the practice and for urgent patient referrals were insufficient.

• Practice procedures to safeguard vulnerable patients were comprehensive and kept patients safe.
• Staff had a good understanding of patients contacting the practice who may need emergency care and treatment.
• Staff involved and treated patients with compassion, kindness, dignity and respect. Patients reported a high level of satisfaction with the way that staff cared for them.
• Patients found the appointment system easy to use and reported they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• 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:

• Continue to monitor the security of loose prescriptions in printers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Euxton Medical Centre on 5 August 2015. Overall the practice is rated as good.

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

• 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 well managed, with the exception of those relating to recruitment checks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles.
• 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.
• A quarterly newsletter about the practice was produced for patients.
• Patients were complimentary about the overall quality of service they received but some said that it was not always easy getting through to the practice by telephone especially in the early morning and getting an appointment was difficult sometimes. Urgent appointments were 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.

There were areas of practice where the provider needs to make improvements.

Importantly the provider must

• Ensure recruitment arrangements include all necessary pre-employment checks for all staff and recruitment policies and procedures reflect current legislation.

In addition the provider should:

• Clinical audits should be accessible to all clinical staff and any learning identified from these shared as part of the practice’s continual learning and improvement.
• Implement plans to improve patient telephone access to the surgery.
• Ensure the practice nurse benefits from clinical supervision and peer support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This is a focused desktop based review of evidence supplied by The Euxton Medical Centre to demonstrate how they have improved the service in the domain or key question of Safe.

Overall, the practice is rated as good. Following this focused desktop review of the practice, we found the practice to be good for providing Safe services.

The Euxton Medical Centre was inspected on the 5 August 2015. The inspection was a comprehensive inspection under the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. At that inspection, the GP practice was rated ‘good’ overall.

However, for the domain or key question Safe, recruitment procedures were identified as ‘requires improvement’ as the practice was not meeting the Regulation 19 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Fit and proper persons employed.

At the comprehensive inspection in August 2015, we found the practice did not have records to confirm all newly recruited staff including some clinical staff had been appropriately vetted to ensure they were suitable and safe to work with potentially vulnerable adults and children. The practice’s recruitment policy was also out of date.

The practice submitted an action plan with timescales detailing how they would ensure they met the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014. They supplied us with evidence to confirm that all staff employed at the practice had been appropriately vetted, that disclosure and barring checks (DBS) were available for all staff, including locum GPs and the practice’s recruitment policy had been updated.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice