We carried out an announced comprehensive inspection at Tollgate Health Centre, on 05 February 2019 as part of our inspection programme.

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 rated this practice as good overall and good for safe, caring, responsive and well-led.

We found that:

• 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 provided care in a way that kept patients safe and protected them from preventable harm. However, they had not formally recorded the infection control work taking place, to evidence any improvement actions that may be needed.
• There was an induction system for new and temporary staff members.
• 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 and treatment.
• The practice listened to their patients to organise and deliver services to meet patients’ needs. This included hosting services normally delivered in secondary care settings.
• Patients told us they could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centred care.
• Leaders at the practice had the capacity and skills to deliver high-quality, sustainable care.
• Staff told us they felt supported, valued, and that clinicians and management valued their support and their opinions.
• Staff and leaders focused on continuous learning and improvement at the organisation, but this required strengthening.

We have rated the practice as requires improvement for providing effective services because;

• We found no system of clinical audit to provide patient quality improvement.

This affected all population groups in the effective domain so they were all rated as requires improvement.

The areas where the provider should make improvements are:

• Continue to evidence formally the infection control work being carried out, to ensure any trends or themes can be recognised.
• Improve the identification of carers to enable this group of patients to access the care and support they need.

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.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice