This practice is rated as Good overall. (Previous rating February 2018 – Requires Improvement)

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 Whitby Group Practice Surgery – Green on 13 November 2018 as part of our inspection programme. We followed up on the areas that required improvement at the previous inspection (February 2018) and found these had improved.

At this inspection we found:

• The practice had 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 reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patient feedback identified that sometimes it was difficult to get through by telephone. The practice was monitoring this and acting to improve access by reviewing the telephone system.
• There were systems in place to mitigate safety risks including health and safety, infection control and dealing with safeguarding.
• 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 reviewed and considered patient views through surveys and a patient participation group (PPG).
• Staff worked well together as a team and all felt supported to carry out their roles.
• There was a focus on learning and improvement at all levels of the organisation.
• The provider was aware of the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Review the practice's storage of historic paper medical records to ensure they are stored safely.
• Review the security of printer prescription pads in the practice to ensure they are safe at all times.
• Review the system for reviewing incidents and significant events to include identification and recording of themes and trends.
• Review the system for implementation of National Institute for Health and Care Excellence guidelines.
• Review the system of appraisal to include salaried GPs.
• Review meetings structures to ensure all meetings are documented and notes of the meetings are disseminated.
• Implement an audit programme/plan that is based on national, local and practice priorities.

This practice is rated as Requires Improvement overall. (Previous inspection 19 November 2015 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

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 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 rated the population groups as Requires Improvement overall because the issues identified as inadequate and relating to patient safety, effectiveness and providing a well-led service affected all patients.

At this inspection we found:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. However, the system for the management of safety incidents was not robust and needed improvement.

• Staff were able to identify and report safeguarding vulnerable adults and children concerns. However, the training of some staff was not up to date.

• The systems to manage high risk medication needed improvement to ensure sufficient safety measures were in place.

• Improvements were needed to the systems to manage infection prevention and control.

• Recruitment records did not contain all the necessary information to demonstrate the suitability of staff.
• A system was not in place to ensure the required safety checks of the premises took place when they were due.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff told us they felt supported and they had access to training and development opportunities appropriate to their clinical and non-clinical roles. However, improvements were needed to ensure all staff had completed the generic training they needed to ensure safe working practices.

• We saw staff treated patients with kindness and respect.

• Access to the service met patient’s needs. Access was monitored to ensure improvements where made if necessary.

• A system was in place to respond to and investigate patient complaints.

• The systems to promote good governance and management were not sufficiently robust.

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

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

• 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 training necessary to enable them to carry out their duties.

• Ensure care and treatment is provided in a safe way to patients.

• Ensure that any complaint received is investigated.

The areas where the provider should make improvements are:

• The cleaning of clinical areas should be documented by all clinicians. Checks undertaken of the standards of cleanliness provided by the cleaners should be documented.

• The vaccine fridges should be hardwired or the plugs should be labelled to prevent them being turned off accidentally.

• Provide guidance to reception staff on how to identify symptoms that might be reported by patients with sepsis and how to respond.

• A risk assessment of the storage of paper patient records should take place.

• A log of MHRA alerts should be maintained so that the action taken and the alert can be referred to.

• The system to ensure alerts are placed on the parents of children where safeguarding concerns have been identified and on the records of vulnerable adults should be reviewed to ensure this alert is placed on all relevant patients’ records.

• The two week rule referral system should be improved by monitoring whether patients have been provided with an appointment.

• Develop a policy and procedure to increase staff awareness of the Accessible Information Standard.

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 Whitby Group Practice Surgery – Green (Also known as Dr England & Partners) on 19th November 2015.

Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Action needed as a result of significant events was cascaded to all staff, however the process for undertaking this between GPs and nursing staff should be formalised. Staff were aware of procedures for safeguarding patients from the risk of abuse.
• There were appropriate systems in place to reduce risks to patient safety, for example, infection control procedures and ensuring sufficient staffing levels were in place to meet the needs of patients. However, improvements were needed to the recruitment records and system in place for ensuring health and safety checks were carried out at the recommended frequencies.

• Although we found no concerns about delayed action when abnormal blood test results were received we found that the system for managing these was informal and results could possibly get overlooked.

• There were systems in place to review patient medication. The management of prescriptions needed improvement however on a further visit to the service this had been addressed. Some further work was needed to establish the best location for the emergency medicines and to ensure GPs had access to secure areas for the storage of prescriptions if required.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff told us they had received training appropriate to their roles. Records of all staff training needed and undertaken needed to be improved to assist in monitoring and planning for the training needs of staff.

• Patients were positive about the care they received from the practice. Survey results showed patients responses about whether they were treated with respect and in a compassionate manner by GP and reception staff were either above average or about average when compared to local and national averages. Responses to some questions in the survey concerning care and treatment by nurses were slightly lower than local and national averages.

• Services were planned and delivered to take into account the needs of different patient groups. The practice worked closely with health and social care services to meet patients’ needs.

• Access to the service was monitored to ensure it met the needs of patients. Patients reported satisfaction with opening hours and said they were able to get an appointment when one was needed. Survey results showed that patient’s satisfaction with access to the practice was generally about or above local and national averages.

• The practice sought patient views about improvements that could be made to the service and acted on patient feedback.

• There were systems in place to monitor and improve quality and identify risk.

The areas where the provider should make improvements are:

• Establish a system to ensure complete documentation is held on recruitment files.

• Develop a more formal system for GPs and nursing staff to review significant events.

• Establish a system for ensuring all blood test results are reviewed in a timely manner.

• Put a system in place to ensure all health and safety checks are carried out at the recommended frequencies

• Ensure there is a complete record of all staff training needed and undertaken to assist in monitoring and planning for the training needs of staff.

• Review the methods for securing prescriptions in use by GPs at the practice and on home visits.

• Risk assess the location of the emergency medication to ensure it is situated in the most accessible area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Whitby Group Practice Surgery (Green) is one of three General Practitioner (GP) practices located within the grounds of Ellesmere Port Hospital. The practice has three GPs, practice nurses, a healthcare assistant and administration staff. There are 5018 patients registered with the practice. The practice is open from 8.00am to 6.30pm Monday to Friday. Patients access the ‘extended hours’ service for routine appointments from 6.30pm. to 8.00pm Monday to Friday and 10.00 am to12.00pm on Saturday mornings. The practice treats patients of all ages and provides a range of medical services. The practice is registered with the Care Quality Commission to deliver the regulated activities:

• Diagnostic and screening procedures
• Family planning
• Maternity and midwifery services
• Surgical procedures
• Treatment of disease, disorder or injury

The practice has systems to monitor patient safety through reporting and learning from incidents and significant events. The practice is aware of improvements needed with infection control procedures and is carrying out a refurbishment programme to improve the environment and facilities. We highlighted additional areas for improving infection control standards during the inspection.

The practice works well with other services and has systems in place which support GPs and other clinical staff to improve clinical outcomes for patients. Patients we spoke with and those who completed CQC comment cards were positive about the care they received from the practice. They commented that staff were caring, helpful and respectful.

The practice has information available to them to inform their understanding of the population they serve. This includes the prevalence of specific diseases and other health and social needs.

Quality monitoring is taking place across the three Whitby Group practices. GPs are developing ways of ensuring governance issues are discussed and monitored within the practice. The practice has systems to seek and act upon feedback from patients using the service, including having an active patient participation group (PPG).

The practice provides a service for all population groups safely and effectively. Staff are caring and responsive to the needs of patients, supported by best practice guidelines.