This practice is rated as requires improvement overall. (Previous rating January 2018 – Inadequate)

There have been three previous inspections of this practice, two of which were comprehensive inspections where ratings were awarded and one, a focused inspection. The focused inspection was carried out to ensure compliance with a warning notice that was served following the January 2018 inspection.

We initially carried out a comprehensive inspection on 8 October 2014. At this time, the practice was rated as good with one area of outstanding.

A comprehensive inspection was also carried out in January 2018 and the practice was rated as inadequate overall and placed into special measures. The practice was issued with two warning notices.

We then carried out a focused inspection to check that the practice had made the necessary improvements required, as highlighted in the warning notice. We found that they had complied with the warning notice.

We then carried out this most recent announced comprehensive inspection at The Lakes Medical Practice on 12 July 2018. This was to check that the practice had made improvements as identified in our previous inspections and to re-rate all key questions and population groups.

The key questions at this inspection are now rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Requires Improvement

At this inspection we found:

• Governance process had improved: partners, clinicians and management staff had lead roles and policies had been updated. There were effective information cascades and staff knew who to go to if they had an issue.
• The practice did not have a fire risk assessment in place.
• There was an improvement to oversight of training requirements and recruitment checks.
• There were effective systems to manage Medicine and Healthcare products Regulatory Agency (MHRA) and other alerts that may affect patient safety. A policy was now in place to action these.
• 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.
• All staff received an appraisal in the last year.
• Feedback from the GP patient survey indicated that patients continued to experience difficulty getting through on the phone and accessing appointments. However, action had been taken by implementing an automated self-service check in desk.
• Some Quality Outcome Framework (QOF) indicators were still below local and national averages.

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:

• The practice should make improvements to how patients access to the service, including access to the practice over the telephone.
• The practice should keep staff up to date with safeguarding training before it expires.
• The practice should have a system in place for quality improvement.
• The practice should review its cancer and two week wait referral rates.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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

This practice is rated as inadequate overall. (Previous inspection October 2014 – Good)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

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 – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those recently retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

We carried out an announced comprehensive inspection at The Lakes Medical Practice on 5 January 2018 as part of our inspection programme.

At this inspection we found:

• The practice did not have clear systems and processes in place. Policies were not easily accessible to staff.

• The practice did not have a system in place to deal with patient safety and medicine alerts.

• There was a lack of record keeping within the practice; meetings were not always documented and safety checks were not recorded.

• The practice acted on significant events and took action to make improvements. Staff were aware of their own responsibilities in reporting events.

• Recruitment checks were not always carried out on staff, and staff files did not always contain the relevant information as set out in schedule three of the regulations.

• Safeguarding procedures were in place and staff understood the signs of abuse and how to report any concerns.

• The practice had systems to monitor performance of the practice and were achieving a quality and outcome framework (QOF) score of 85%.

• 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 told us they did not find the appointment system easy to use and sometimes struggled getting an appointment

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

• The provider should have regular team meetings

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

Letter from the Chief Inspector of General Practice

We inspected The Lakes Medical Centre on the 8th October 2014 as part of our new comprehensive inspection programme.

Our inspection team was led by a CQC Inspector and a GP. The team included a practice manager and an expert by experience. We reviewed information provided to use leading up to the inspection and spent seven hours on-site speaking to 13 members of staff, nine patients and reviewed 36 CQC comment cards which patients had completed leading up to the inspection. From all the evidence gathered during the inspection process we have rated the practice as good.

During our inspection the majority of comments from patients were positive about the care and treatment people received. Patients told us they are treated with dignity and respect and involved in making decisions about their treatment options.

A small number of patients reported difficulty in making timely routine appointments with a GP, however they reported where emergency appointments were required these were accommodated on the same day.

Feedback included individual praise of staff for their care and kindness and going the extra mile.

Our key findings were as follows:

• Patients said they were treated with compassion, dignity and respect and they were involved in care and treatment decisions.
• Staff understand their responsibilities to raise concerns, and report incidents.
• The practice is clean and well maintained.
• There are a range of qualified staff to meet patients’ needs and keep them safe.
• Data showed us patient outcomes were at or above average for the locality. People’s needs are assessed and care is planned and delivered in line with current legislation.
• The practice works with other health and social care providers to achieve the best outcomes for patients.
• Majority of patients reported good access to the practice and a named GP and continuity of care, with urgent appointments available the same day.

We saw several areas of outstanding practice including:

• The care for patients at the end of life was outstanding. The practice had a lead GP for end of life care within the practice, and a GP who took a lead within the CCG for developing end of life care within Salford. The practice had carried out an end of life care audit, which showed that 100% of patients in the latter stages of life had a statement of intent in place. A statement of intent is where all palliative care patients expected to be on their last days, should with consent have information shared with out of hours providers to ensure consistency of care and a shared understanding of the patient’s wishes.
• The practice provided an enhanced service for refugees. The purpose of this enhanced service was to deliver primary medical care to refugees placed within Salford by providing patient centred, systematic and on going support during the 12 months following arrival and beyond. The practice provided refugee patients with access to all services.

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

Importantly the provider should:

• Devise a policy and procedures for staff to ensure guidance and continuity in relation to consent, or guidance for staff on how to take appropriate action where people did not have the capacity to consent in line with the Mental Capacity Act 2005.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Lakes Medical Practice on 22 February 2019 as part of our inspection programme.

At the last comprehensive inspection in July 2018 we rated the practice as good for the key questions safe and caring; and requires improvement for effective, responsive, and well-led. The overall rating was requires improvement. This was because:

• The practice had not established effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

At this inspection, we found that the provider had satisfactorily addressed these areas.

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 have now rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was well-led and managed the delivery of high-quality, person-centre care.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Rosie Benneyworth

Chief Inspector of General Practice