This practice is rated as Good overall. (Previous inspection April 2015 – Good)

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? - 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 Albion Medical Practice on 12 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice had some systems in place 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. However system to manage medicines and the system to monitor action taken in light of Medicines and Healthcare products Regulatory Authority (MHRA) required improvement.
• The practice 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.
• Patient’s feedback was mixed in relation to the appointment system, however they reported that they were able to access urgent care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

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

• Ensure care and treatment is provided in a safe way to patients in relation to the proper and safe management of medicines. 

The areas where the provider should make improvements are:

• Ensure lessons learnt from significant events are documented and learning is shared with all appropriate staff.
• Ensure systems are in place to have oversight of vulnerable patients.
• Formalise the system for monitoring uncollected prescriptions.

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 Albion Medical Practice on 7th April 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for all the population groups with some outstanding practice for older people.

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 although we were alerted to a significant event that had not been formally reported.
• Following our last inspection, when a compliance action had been issued about the management of medicines, the practice manager had shared our findings with the other practices in the Clinical Commissioning Group (CCG) in an effort to improve cold chain management throughout the entire CCG.
• Information about safety was recorded, monitored, appropriately reviewed and addressed.
• The practice had adopted the Gold Standards Framework to deliver care to their patients. GSF is a way of working adopted by GP practices which involves them working as a team with other professionals in hospitals, hospices and specialist teams in order to provide the highest standard of care possible for patients and their families
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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 mostly said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.

We saw an area of outstanding practice:

The practice had recently employed a team of staff to provide an “Over 75s” project and work specifically with the 797 older patients at the practice and maximise the quality of care provided to this group. A GP, community liaison nurse and the services of a pharmacy technician had been secured. The team were working with this age group to provide advice and promotion of good health, a point of contact for signposting, post-hospital discharge visits, advice with finances and reviews of medication. We saw three examples where this team had a positive impact on patients and promoted good outcomes.

There were areas of practice where the provider needs to make improvements.

The provider should :

• Ensure that all members of staff are encouraged to report and record all significant events that happen within the practice.

• Ensure that all staff files contain the required documentation with regard to employment, such as satisfactory evidence of conduct in previous employment.

• Ensure that non-disposable curtains in consulting and treatment rooms are laundered at least six monthly and that dates are documented and kept for future reference.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The practice were registered to carry out activities in relation to diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and the treatment of disease, disorder or injury. Staff included five partners, trainee GPs, nurses, health practitioners, administrators and receptionists. We spoke with 13 patients, four by telephone before the inspection and also talked to 11 members of staff.

Patients told us they were very happy with the care and treatment they received and they felt safe. There were robust systems in place to help ensure patient safety through learning from incidents and the safe management of medicines. Staff were able to describe how they would deal with any cases of abuse or emergency and were trained on how to keep people safe.

The service is effective in obtaining patients’ views regularly and these are used to make improvements to the service provided. Complaints and adverse incidents were recorded and dealt with appropriately.

The provider is responsive and the practice is well led. Access to the service is offered in varying ways and to people in different population groups. There are clinics to help people with long term conditions, mental illness and learning disabilities. However there is no system in place to proactively reach people in vulnerable circumstances who find it difficult to access primary care services.

Although there is a system in place to check and regulate the temperature of the fridges where medication is kept, we found that this system is not effective. When we checked the fridge temperatures we found they had been continually recorded at heights that would render medication unsafe for use if the temperature had been as recorded. This had not been reported, escalated or dealt with and had occurred over a substantial period of time.

There is no evidence that a cold chain policy is in place. This policy is required to ensure that medicines are stored at the correct temperatures and that staff understand what to do in the event of a breakdown in systems.

This meant the practice were in breach of Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2010 Medicines Management, because patients were not protected against the risks associated with medicines.