This practice is rated as Good overall. The practice was previously inspected on 6 December 2017 and received a rating of Requires Improvement for providing safe and well led services, which led to a rating of Requires Improvement overall.

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 Todmorden Group Practice on 26 July 2018. We carried out this inspection to review the changes the practice had implemented since their previous inspection, and to follow up on the breach of regulation identified at that time.

At this inspection we found:

• The practice had revised their staffing structure and had identified clear leadership areas in relation to clinical and non-clinical governance. Staff were clear about the leadership structure and their roles and responsibilities within the organisation.
• There were appropriate systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them, communicated them to staff, and improved their processes.
• Policies and protocols in relation to staff activity had been reviewed and updated. We viewed a sample of these and saw they were up to date and gave relevant guidance.
• Staff recruitment, training and ongoing monitoring processes had been reviewed. These were effective and safe.
• Health and safety issues were addressed in the practice. An external agency provided and updated risk assessments to support the provision of a safe environment for staff and patients.
• Staff told us the practice had a culture of openness and the senior leadership team was supportive.
• The practice had good facilities and a number of additional services including hospital consultant clinics were available to patients on site.
• The practice was part of ‘Calderdale Group Practice’, a group of 11 practices developing shared back office functions to improve resilience.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to up to date evidence based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patient feedback in relation to the appointment system was mixed. Some patients told us GP appointments could be difficult to obtain.
• Continuous learning and improvement was supported for all staff via the appraisal process.

The areas where the provider should make improvements are:

• Embed communication systems and processes in the practice to ensure that there is a sustained forum for two-way staff feedback.
• Continue to review and improve access to the practice, including GP appointments for patients and telephone access in general.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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

Letter from the Chief Inspector of General Practice

This practice is rated as requires improvement overall. The previous inspection, carried out on 1 March 2016 rated the practice as good overall, and requires improvement for providing well-led services.

The key questions are rated as:

Are services safe? – Requires improvement

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 – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) – Requires Improvement.

We carried out an announced comprehensive inspection at Todmorden Group Practice on 6 December 2017. We carried out this inspection as part of our inspection programme, and to review improvements or changes made to the leadership of the practice since our last inspection.

At this inspection we found:

• The practice had systems in place to report incidents and near misses. Incidents were logged and discussed on a case by case basis. However learning from incidents was not always communicated effectively.

• Staff induction and training systems were in place. However we found that where staff had been externally supplied, assurances in relation to competency and medical indemnity cover were not established prior to employment.

• Staff were not clear about who had responsibility in lead areas for clinical governance issues. We were not assured that the leadership areas identified as requiring improvement in the inspection conducted on 1 March 2016 had been fully addressed.

• The practice had a number of policies and protocols in place in relation to staff activity. However the practice was unable to demonstrate oversight and review of these, as most were not dated and had no identified review date. Following receipt of the draft report the practice advised us that this had been rectified.

• Some staff told us they did not always feel supported by the senior leadership team.

• The practice participated in Calderdale Clinical Commissioning Group Commissioning Engagement Scheme in relation to assessing and monitoring the quality of services provided. However, we did not see evidence of completed, two cycle audits to address key areas of performance and improvement.

• There were externally developed policies, systems and processes to manage health and safety within the practice.

• The practice had infection prevention and control measures in place. However we identified shortfalls in relation to some checking and logging processes.

• Regular clinical and staff meetings were held, however we saw limited evidence that key governance areas such as significant events, complaints, patient and medicine safety alerts and other clinical updates were routinely discussed and reviewed.

• The practice had systems for dealing with complaints in line with national timescale requirements. Not all written communications with patients contained Parliamentary and Health Service Ombudsman details.

• The practice was piloting a same day access scheme to improve access to appointments.

• The practice had good facilities and a number of additional services were provided on site.

• We observed patients being treated with compassion and respect. The practice participated in the local ‘Altogether Better’ service, which made use of health champions to engage patients in a number of social inclusion activities to reduce isolation and enhance well-being.

The areas where the provider must make improvements as they are in breach of regulations 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:

• Review prescription security processes within the practice in line with the current guidance.

• Review and improve their communications with complainants to assure themselves that they are always advised of the options available to them if they are not happy with the outcome of their complaint.

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 Todmorden Group Practice on 1 March 2016. Overall the practice is rated as good. However, we rated the practice as requiring improvement for providing well led services.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• Patients told us that access to appointments had recently improved. Telephone consultations and same day appointments were available.
• The practice had very good facilities and was well equipped to treat patients and meet their needs.
• The leadership structure was in a period of transition. Some staff expressed they did not always feel fully supported by GP partners and management. New systems were being developed to improve communication and feedback between the different staff groups
•  The practice proactively sought feedback from patients and acted upon this feedback.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvements are:

• Ensure the practice has a clear direction and set of priorities.

• Ensure that there is a clear leadership structure

• Include health assessments in recruitment processes for new staff.

• Complete annual appraisals and personal development plans for all staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Our inspection on the 8 July 2013 found the provider was not always consulting patients when decisions were made to change the services. Also they were had not reviewed whether patients had sufficient access to appointments with the GPs. Following the inspection the provider wrote to us and told us they would take action to ensure they were compliant with these essential standards.

At this inspection we found that improvements had been made. The provider had informed and consulted with the patient participation group (PPG) about any changes to the practice. They now reviewed patient’s access to appointments with GPs and were constantly looking at ways of making improvements.

We looked at the medical records of eight people to identify if their health needs were assessed and the planning of care ensured the safety and welfare of the person. We also spoke with a selection of both clinical and non-clinical staff. We spoke with eight people who used the service in the waiting room.

From the clinical records sampled, we saw people's presenting symptoms were documented along with any investigation/actions and proposed treatment. We also saw copies of correspondence between GP's and other health care professionals. We were satisfied people's health needs were assessed and care was delivered in a way to ensure their safety and welfare.

From our discussion with people in the waiting area and review of complaints, we identified that the practice did not have appropriate systems in place to review and assess the risk in relation to accessing the regulated activities.

All the staff we spoke with spoke positively about the practice manager and the support they received from the partners.