We carried out an announced comprehensive inspection at Ashbourne Medical Practice on 8 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 all population groups.

We found that:

• 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.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

We rated the practice as Requires Improvement for providing safe services because:

• The practice building and environment was managed by the adjoining St Oswalds hospital however the practice did not always have the assurance that the building was fit for purpose.
• We found some systems ineffective at ensuring that medicines were in date and located in secure environments. We found bags of equipment and full sharps boxes which the practice were unaware of.
• The PGDs in use were not correctly signed.
• The practices system for monitoring the cold chain did not assure that medicines were kept in optimum conditions and fit for use.
• There were not always comprehensive risk assessments to ensure that the practice complied with health and safety or infection prevention and control purposes.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way (Please see the specific details on action required at the end of this report).

In addition, the provider should:

• Review the practice's risk management systems for monitoring and mitigating the various risks arising from the undertaking of the regulated activities. 
• Review the systems and processes for learning, continuous improvement and innovation.

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

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 Ashbourne Medical practice on 19 October 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 to report significant events.Information about safety alerts was reviewed and communicated to staff by the practice manager in a timely fashion.

• Risks to patients were assessed and well managed through practice meetings and collaborative discussions with the multi-disciplinary team.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. This was kept under review by the practice which proactively used audit as a way of to ensuring that patients received safe and effective care

• All members of the practice team had received an annual appraisal and had undertaken training appropriate to their roles, with any further training needs identified and supported by the practice.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs. For example; the practice met monthly with the community health and social teams and include voluntary organisations in their case reviews for patients with complex needs in order to explore more suitable options and outcomes in a timely way.

• Results from a national survey and patients we spoke with told us that doctors and nurses at the practice treated them with compassion, dignity and respect and they were involved in their care and decisions about their treatment. We saw that Information was available to help patients understand the care available to them.
• Information about services and how to complain was available in the reception area and patients told us that they knew how to complain if they needed to.
• Urgent appointments were available on the day they were requested. However, patients said that they sometimes had to wait a long time for non-urgent appointments.
• The practice was purpose built, had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff told us they felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on. Staff appeared motivated to deliver high standards of care and there was evidence of team working throughout the practice

We saw an area of outstanding practice:

• We found the practice was outstanding in ensuring that services were tailored to suit the needs of individual patients. In particular, staff were actively involved in muti-disciplinary workingthat ensured the most appropriate delivery of care. The multi-disciplinary team was fully inclusive and included social care and the voluntary sector which enabled co-ordinated planning of care amongst multiple professionals for patients at risk of unplanned admissions into hospital

However there were areas of practice where the provider should make improvements:

• The practice should ensure the records from complaints and significant events clearly reflect the actions taken and outcomes of the investigation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice