Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Junction Alkrington Surgery on 23 January 2017. Overall the practice is now rated as good.

The practice had been previously inspected on 8 June 2016. Following that inspection the practice was rated as requires improvement with the following domain ratings:

Safe – Inadequate.

Effective – Good.

Caring – Good

Responsive – Requires improvement

Well Led - Requires improvement

• The practice did not ensure that adequate recruitment checks were carried out
• They did not carry out regular health and safety and infection control risk assessments and procedures were not in place to manage risks.
• Not all staff received training linked to their roles and responsibilities or had appraisals.

The practice provided us with an action plan detailing how they were going to make the required improvements.

The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for The Junction Alkrington Surgery on our website at www.cqc.org.uk.

The full comprehensive inspection on 23 January 2017 was to confirm the required actions had been completed and award a new rating if appropriate. Following this re-inspection, our key findings across all the areas we inspected were as follows:

Since the last inspection the practice had made the following improvements:

• The practice had implemented a new policy to carry out all recruitment checks when employing new members of staff. All current members of staff had received a check with the Disclosure and Barring Service.
• A member of staff had been delegated as infection control lead and had carried out an infection control audit and all identified risks had been actioned.
• A health and safety policy had been implemented and a recent audit carried out.
• The use of an autoclave used to sterilise equipment had ceased and the practice was now using single use medical equipment.
• Systems were implemented to ensure that all medicines, vaccinations and clinical supplies were within their expiry date.
• The transport of and use of liquid nitrogen had been suspended until training in the use of hazardous substances had been carried out.

Other key findings were as follows:

• The practice had a systematic process of dealing with and monitoring updates and guidelines from the National Institute for Health and Care Excellence (NICE).
• Feedback from patient surveys and Family and Friends test were consistently positive about the practice. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• The practice had set set up a befriending service where volunteer members of the patient participation group worked with the Royal Voluntary Service and went to meet patients on the day that they were discharged from hospital and offered ongoing support. The practice told us that the scheme had helped to reduce re-admission rates when deployed elsewhere in the country.
• The practice offered a Telephone Crisis Brief Intervention Scheme where patients were able to telephone the surgery and a mental health worker, employed by the practice, would offer advice. This scheme resulted in a reduction of patients attending A&E departments and walk in centres.

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 Junction Alkrington Surgery on 23 January 2017. Overall the practice is now rated as good.

The practice had been previously inspected on 8 June 2016. Following that inspection the practice was rated as requires improvement with the following domain ratings:

Safe – Inadequate.

Effective – Good.

Caring – Good

Responsive – Requires improvement

Well Led - Requires improvement

• The practice did not ensure that adequate recruitment checks were carried out
• They did not carry out regular health and safety and infection control risk assessments and procedures were not in place to manage risks.
• Not all staff received training linked to their roles and responsibilities or had appraisals.

The practice provided us with an action plan detailing how they were going to make the required improvements.

The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for The Junction Alkrington Surgery on our website at www.cqc.org.uk.

The full comprehensive inspection on 23 January 2017 was to confirm the required actions had been completed and award a new rating if appropriate. Following this re-inspection, our key findings across all the areas we inspected were as follows:

Since the last inspection the practice had made the following improvements:

• The practice had implemented a new policy to carry out all recruitment checks when employing new members of staff. All current members of staff had received a check with the Disclosure and Barring Service.
• A member of staff had been delegated as infection control lead and had carried out an infection control audit and all identified risks had been actioned.
• A health and safety policy had been implemented and a recent audit carried out.
• The use of an autoclave used to sterilise equipment had ceased and the practice was now using single use medical equipment.
• Systems were implemented to ensure that all medicines, vaccinations and clinical supplies were within their expiry date.
• The transport of and use of liquid nitrogen had been suspended until training in the use of hazardous substances had been carried out.

Other key findings were as follows:

• The practice had a systematic process of dealing with and monitoring updates and guidelines from the National Institute for Health and Care Excellence (NICE).
• Feedback from patient surveys and Family and Friends test were consistently positive about the practice. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• The practice had set set up a befriending service where volunteer members of the patient participation group worked with the Royal Voluntary Service and went to meet patients on the day that they were discharged from hospital and offered ongoing support. The practice told us that the scheme had helped to reduce re-admission rates when deployed elsewhere in the country.
• The practice offered a Telephone Crisis Brief Intervention Scheme where patients were able to telephone the surgery and a mental health worker, employed by the practice, would offer advice. This scheme resulted in a reduction of patients attending A&E departments and walk in centres.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

We undertook a follow up inspection to The Junction Alkrington Surgery on the 4 June 2014.

We did not speak to people who used the service during this inspection.

We found that since our last inspection the registered provider was now operating a robust recruitment process and one that fully protected patients.

We found that since our last inspection the registered provider had listened to patient feedback and had taken action to improve the quality of the service provided to patients.

During our inspection we found that the provider carried out their regulated activities from two locations but had only registered one of these locations with the Care Quality Commission. We told the provider that they were currently not registered to carry out regulated activities from the additional location and they must apply to add this to their registration immediately.

All consultation rooms were accessible to patients using a wheelchair or pushing a pram.

No early morning or late night appointments were available but patients could access late night and weekend appointments at a nearby medical practice. Drugs and equipment were available for use in a medical emergency.

All areas of the practice were visibly clean. There was a cleaning schedule in place and the cleaner signed to confirm each task had been completed.

The practice did not follow the procedures set out in its recruitment policy. Disclosure and barring service (DBS) checks had not been carried out for relevant staff, and the work history of staff was not checked.

Some clinical audits took place but the provider did not have a system in place to monitor the quality of the service provided or assess the satisfaction of patients.

Patients told us they were treated respectfully and felt involved in decisions about their care. Some told us they had difficulty accessing appointments and had difficulty getting through to the practice on the telephone.