This practice is rated as Good overall. At the previous Care Quality Commission (CQC) inspection in March 2016, the practice received a good overall rating.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

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

People whose circumstances may make them vulnerable – Good

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

We carried out an announced comprehensive inspection at Ailsworth Medical Practice on 21 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. The practice had a regular agenda item at meetings to discuss safety incidents.
• The practice had systems in place to safeguard patients from abuse. The practice regularly reviewed all documentation for children who were not brought for appointments.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided through clinical audit. It ensured that care and treatment was delivered according to evidence based guidelines.
• The practice had achieved 100% performance for the Quality and Outcomes Framework.
• Staff involved and treated patients with compassion, kindness, dignity, and respect. Results from the national GP Patient Survey reflected this; all the results were above the CCG and national averages.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice responded to complaints in a timely and open manner.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• There was a positive culture within the practice and staff reported the management team were supportive and approachable.
• The practice worked across three sites with the main site at Ailsworth which was limited in the clinical and office space available. The practice told us that this compromised some of the services including GPs and nursing sessions they were able to offer. The practice was in discussion with the local planners to extend the building.
• We found some inconsistencies in monitoring of quality and performance across the two sites we visited for example access to policies and procedures.
• The practice told us they monitored quality and performance such as referrals by locum staff and filing of electronic mail but did not always record these.
• The practice was in the process of recruiting additional staff; they had recognised that at times of staff absence some backlogs occurred.

The areas where the provider should make improvements are:

• Review and strengthen the systems and processes to monitor quality and performance to ensure that performance of non-clinical tasks and the policies to support them are consistent across all three sites.
• Review and formalise the risk assessment in relation to accepting telephone requests for medicines from patients.
• Review the systems and process to ensure that all monitoring undertaken of quality and performance is formally recorded to enable trend analysis of any identified issues.

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 Ailsworth Medical Centre on 21 March 2016. This was to check that the practice had taken sufficient action to address a number of significant shortfalls we had identified during our previous inspection in June 2015. Following this inspection in June 2015, the practice was rated as inadequate for providing safe and well-led services; as requires improvement for providing effective and responsive services; and good for providing caring services. Overall it was rated as inadequate. We also issued three warning notices and one requirement notice under the Health and Social Care Act 20018 and placed the practice in special measures as a result.

During this inspection, we found that the practice had taken sufficient action to address the breaches in regulations. For example, infection control procedures had improved significantly, staff training and appraisal had increased, complaints and significant events were analysed more closely, and governance systems were more robust. Overall the practice is rated as good.

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.
• There was a robust programme of infection control audit in place which was facilitated by the infection control lead nurse.
• 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 well and were involved in their care and decisions about their treatment.

• Given the small size of the practice, staff knew their patients well and offered a very personal service.

• Palliative care was good, and those patients recently bereaved were well supported.
• Information about services and how to complain was available and easy to understand.
• 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.

There were areas where the provider should make improvements:

• Review the use of CCTV cameras to ensure it meets guidance as set out in the Information Commissioner’s’ Office; In the picture: A data protection code of practice for surveillance cameras and personal information.

• Review the repeat prescribing policy for patients.

• Put formal systems in place to ensure all clinicians are kept up to date with national guidance and guidelines

I confirm that this practice has improved sufficiently to be rated ‘Good’ overall. The practice will be removed from special measures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

At our inspection on 17 September 2015, we followed up enforcement action that we had taken following our comprehensive inspection on 15 June 2015. The inspection report for the comprehensive inspection can be found on the CQC website. Following the comprehensive inspection we issued a warning notice to the practice because there was immediate risks to patients that required urgent attention by the practice in relation to infection control procedures. This was in breach of Regulation 12(1)(2)(h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We returned on 17 September 2015 to ensure the practice had taken action to mitigate these risks and complied with the regulation.

We found the provider had made appropriate improvements in ensuring that suitable arrangements were in place to assess, prevent and control the risks of infection. We found that;

• A member of staff had been delegated the lead responsibility for infection control
• A programme of infection control audits had been completed and an annual plan was in place.
• There were adequate systems in place to seek assurance that the premises, including clinical equipment, were being regularly cleaned to a satisfactory standard
• Infection prevention and control had been given a higher priority within the practice. An infection control group met regularly and there were clearer systems in place to communicate issues and share information with the staff team.
• We observed improved management of clinical waste and sharps.

The practice continues to operate within the special measures applied by the CQC and will continue to do so for six months. After this time, CQC will revisit and re-inspect Ailsworth Medical Centre and will amend our judgements and ratings.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ailsworth Medical Centre on 15 June 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice to be inadequate for providing safe and well led services. We found that the practice required improvement for effective and responsive services. The practice was good for providing caring services. It was overall, inadequate for providing services for older people, people with long-term conditions, families children and young people, working age people (including those recently retired) and people experiencing poor mental health (including people with dementia).

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded and reviewed although this was not always in depth so that learning could be maximised.
• Risks associated with the safe running of the service were not always assessed or well managed such as infection prevention and control measures and health and safety risks.
• Data showed patient outcomes were average for the locality. Few audits had been carried out and we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
• 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 but required a review so that patients were enabled to raise concerns or complaints in any format.
• Urgent appointments were usually available on the day they were requested. Most patients said that they had access to an appointment when they needed one.
• The practice had some policies and procedures to govern activity, but some of these did not contain key information to guide staff and required a review. The practice did not have an established process to communicate and review governance issues to ensure that actions were continually reviewed.
• The practice sought feedback from a patient participation group. Other methods of seeking feedback from staff and patients could be improved.

The areas where the provider must make improvements are:

• Improve the arrangements for the security and storage of blank prescription forms.
• Improve the safety of medicines by; completing a risk assessment for the security of medicines, introducing a policy to ensure medicines are stored at the required temperature and introducing formal checks on the management of high risk medicines.
• Ensure the recruitment process follows the policy and that the appropriate records are maintained for all staff.
• Review the systems in place for assessing the risk of, and preventing, detecting and controlling the spread of infections.
• Ensure that staff receive appropriate training and a performance appraisal so that they can carry out the duties they are employed to perform.
• Ensure there are effective systems or processes in place to access, monitor and improve the quality and safety of the services provided. This should include reviewing formal governance arrangements, policies and procedures, systems for information governance, equipment checks and health and safety risk management.

In addition the provider should:

• Ensure there is a clinical audit plan in place that includes completed clinical audit cycles.
• Ensure that new clinical practice guidelines are routinely discussed in practice meetings. 
• Ensure that records of multidisciplinary working are completed. Records of significant events and complaints should provide sufficient detail to ensure that learning is maximised and actions are completed.
• Review the staffing skill mix to ensure that suitably qualified and skilled staff are available to meet patients’ needs.
• Review the toilet facilities to ensure they are accessible for patients with a disability
• Ensure staff are confident in using the electronic alerts to identify patients with particular needs such as a disability.
• Inform patients and visitor to the practice that CCTV cameras are in operation.
• Improve the complaints process so that verbal concerns and complaints are monitored and any actions taken as a result of the complaint are followed up. Ensure that patients are aware that they can raise concerns and complaints in any format.

On the basis of the ratings given to this practice at this inspection (and the concerns identified at the previous inspection in September 2014), I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This inspection took place so that we could follow up enforcement action that we had taken after our comprehensive inspection on 15 June 2015. The inspection report at that time rated the practice as inadequate overall and the practice were placed into special measures. You can find the report for the comprehensive inspection on the CQC website (www.cqc.org.uk). Following the comprehensive inspection we issued a warning notice to the practice because there was immediate risks to patients that required urgent attention by the practice in relation to staffing and good governance. This was in breach of Regulations 17(1)(2)(a)(b)(d)(i)(ii) and 18(2)(a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We returned on 21 and 22 October 2015 to ensure the practice had taken action to mitigate these risks and complied with the regulations.

We found the provider had made appropriate improvements in ensuring that suitable arrangements were in place to improve systems to monitor the quality and safety of the service and ensure that staff received sufficient training and support. We found that;

• Systems were in place to manage fire safety, the safety of the premises and equipment. A risk management log was in place to help improve monitoring procedures.
• Information governance systems had improved and action had been taken to secure the management of information. For example all staff had received information governance training.

• Evidence of recruitment checks had improved and staff who had received disclosure and barring service checks (DBS) from a previous employer, had reapplied for a check as an employee of Ailsworth Medical Centre.
• Staff training, support and annual appraisal systems had been improved so that staff had completed training, or were aware of the mandatory and personal development training that they were being supported to complete.
• Governance systems had been strengthened and provided evidence to demonstrate that quality improvements were being identified and actioned to promote improvement.

We found the provider should also;

• Review the practice’s recruitment policy to include guidelines on using portable DBS checks.
• Take action to ensure that medicines are stored securely at the Newborough practice.
• Ensure that copies of training certificates are sought for their own records of assurance

The practice continues to operate within the special measures applied by the CQC and will continue to do so for a total of six months from the publication of the report. After this time, CQC will revisit and re-inspect Ailsworth Medical Centre and will amend our judgements and ratings in accordance with our findings at that time.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice