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

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at The Family Practice on 21 March 2019 as part of our inspection programme.

At this inspection we found:

• The practice had embedded the improvements seen at our last inspection.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice was performing better than peers in a number of performance indicators.
• There was a focus on continuous learning and improvement at all levels of the organisation

The practice worked with the local clinical commissioning group and the federation of GPs to support increased access for patients. This included extended hours at sites in the locality and access to NHS GPs through a smartphone app.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

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

We previously carried out an announced comprehensive inspection at The Family Practice on 15 June 2017. The overall rating for the practice was requires improvement. The practice was rated requires improvement for providing safe and responsive services and rated good for providing caring, effective and well-led services. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for The Family Practice on our website at www.cqc.org.uk.

This inspection was an announced follow-up inspection carried out on 15 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 15 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good and is rated good for providing safe and responsive services.

Our key findings were as follows:

• Patients prescribed high risk medicines were being monitored appropriately.
• Appointments with GPs were available to book in person, by telephone and online. Other appointments could be booked in person or by telephone.

In addition we saw evidence of:

• The practice was monitoring management of long term conditions including improvement to the clinical system used for recording annual reviews. Regular discussions were held at clinical meetings and refresher training had been given to staff to help with long term condition management. The practice was on track to meet its performance targets for this year.
• The practice was proactively identifying and supporting carers, and had identified 4% of the practice population as carers.

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 Family Practice on 8 September 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. We carried out a focused inspection on 13 April 2017 to ensure that the practice had complied with legal requirements. The full comprehensive report on the 8 September 2016 and the focused report on the 13 April 2017 inspection can be found by selecting the ‘all reports’ link for The Family Practice on our website at www.cqc.org.uk.

After the inspection in September 2016 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

This inspection was an announced comprehensive inspection undertaken on 15 June 2017, following the period of special measures. Overall the practice is now rated as requires improvement.

Our key findings were as follows:

• Patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Leadership and culture supported provision of high quality patient care and enabled staff to deliver that.
• All staff had completed training appropriate to their job role.
• There was an effective system for identifying, capturing and managing risks and issues.
• The practice had a number of policies and procedures to govern activity.
• The practice proactively sought feedback from staff and patients, which it acted on.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

However, there were also areas of practice where the provider needs to make improvements.

The provider must:

• Monitor the availability and booking processes of non-urgent appointments and embed new systems for improving access to appointments.

The provider should:

• Review systems for monitoring patients prescribed high risk medicines.
• Consider the use of exception reporting and the best ways to support patients.
• Consider how to best identify and support carers.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

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 Family Practice on 08 September 2016. The overall rating for the practice was inadequate. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for The Family Practice on our website at www.cqc.org.uk.

During the inspection we found breaches of legal requirements and the practice was rated inadequate overall. The practice was rated inadequate for providing safe and well-led services, requires improvement for providing caring and responsive services and good for providing effective services. Following this inspection we issued a warning notice that the practice must comply with the legal requirements in relation to the following:-

• Ensuring that vaccines were always stored in line with Department of Health guidance and stocks of medical equipment were monitored and fit for use.
• Ensuring the proper and safe management and disposal of medicines.
• Doing all that is reasonably practicable to prevent, detect and control the spread of infections, to patients and staff.
• Ensuring systems are in place to securely store confidential information about service users.
• Ensuring staff are appropriately authorised to administer vaccines and immunisations in line with national requirements.
• Ensuring that risk assessments are up to date and mitigating actions implemented.
• Ensuring that all GPs and staff have completed adult and child safeguarding training appropriate to their role and that all staff are able to easily locate safeguarding policies.

This inspection was an announced focused warning notice inspection carried out on 13 April 2017 to confirm that the practice had carried out their plans to meet the legal requirements in relation to the breaches in regulations identified in the warning notice issued following our previous inspection on 08 September 2016. This report covers our findings only in relation to the requirements of the warning notice and will not result in reviewing the overall rating or the ratings of any individual key question or population group.

At this inspection, 13 April 2017 we found that the practice met the legal requirements in relation to the breaches in regulations identified in the warning notice issued following our previous inspection on 08 September 2016.

Our key findings at this inspection, 13 April 2017, were as follows:

• Vaccines and medicines were being stored in accordance with manufacturer’s instructions and Department of Health Guidance and this was being monitored appropriately.
• Clinical waste, including medicines, was being stored and disposed of safely.
• Confidential information about service users was being stored securely.
• Staff were being appropriately authorised to administer vaccines and medicines in line with national requirements.
• Risk assessments were up to date and mitigating actions were being implemented.
• All GPs and staff had completed adult and child safeguarding training appropriate to their role and staff could easily locate safeguarding policies.

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 Family Practice on 08 September 2016. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, for at least the last three months prior to our inspection vaccines had not been stored in accordance with manufacturer’s instructions which meant patients have been given potentially ineffective vaccines. There were also concerns regarding recruitment checks, training, infection control, risk assessments, medicines management, storage of clinical waste and the storage of patient records.
• Although patients were positive about their interactions with staff on the day of inspection we observed some staff who did not treat patients with respect or compassion.
• Appointment systems were not working well so patients reported that they did not receive timely care when they needed it, however urgent appointments were available on the day they were requested. Patients told us they sometimes queued for up to an hour and a half to book an appointment.
• The practice did not have sufficient monitoring in place to ensure that practice policies and protocols were being used appropriately.
• The practice had developed in house templates for use with the clinical system that clinicians completed to clearly and consistently record safeguarding information and consent.
• Clinical audits demonstrated quality improvement.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The culture and leadership of the practice were not enabling staff to provide high quality care.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

The areas where the provider must make improvements are:

• Review the leadership and culture to support provision of high quality patient care and enable staff to deliver that.
• Ensure that training appropriate to job role is completed by all clinical and non-clinical staff and GPs, including safeguarding children and vulnerable adults.
• Ensure that all appropriate risk assessments are completed including a risk assessment on how the practice deals with medical emergencies and a Legionella risk assessment and that actions identified from risk assessments are completed and recorded. This includes ensuring recruitment arrangements include all necessary employment checks for all staff
• Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which is reflective of the requirements of the practice. This includes ensuring that written Person Specific Directions (PSD) are in place for the health care assistants, all vaccines and medicines are stored in accordance with the manufacturer’s instructions, clinical and medicine waste is disposed of safely and patient records are stored securely.

The areas where the provider should make improvement are:

• Improve processes for making appointments.
• Review the inclusion of all staff in clinical and non-clinical decisions.
• Review where emergency equipment including emergency medicines is stored and whether it is in an appropriate location that is easily accessible to all staff.
• Review the risks of using friends and family to translate and as advocates at times of obtaining consent and providing treatment.
• Review the signage of the toilet identified as suitable for disabled patients.
• Review how patient privacy is maintained at all times.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice