We carried out an announced comprehensive inspection at Beehive Surgery on 1 February 2019 as part of our inspection programme. The previous inspection had been in February 2018 where the practice was rated good in all domains.

We based our judgement of the quality of care at this service is 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.

We rated the practice as outstanding for providing responsive services because:

• Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.
• There were innovative approaches to providing integrated person-centred care.
• The practice had identified areas where there were gaps in provision locally and had taken steps to address them.

We also rated the practice as good for providing safe and effective, caring and well-led services because:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• 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 way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We saw several areas of outstanding practice including:

• The practice had worked with the local mosque in the past 18 months. They had provided health information to members of the mosque and some information had been displayed for members to read. This partnership working had increased recently. In October 2018 the female partner was asked to talk to approximately 200 women about healthy lifestyles and health screening. Positive feedback had been provided and the partner was invited again in December 2018, this time to talk to approximately 500 mainly women, although some men were in attendance. The partners were currently in discussion with the male leaders from Bolton Council of Mosques about further talks to wider audiences.
• The practice worked with a health practitioner from Royal Bolton NHS Foundation Trust to deliver organised health walks once a month. Patients met at the practice to participate in the walks and a map of the walk was displayed in the waiting area so patients could join the walk at other starting points if these were more convenient. To maximise the impact of the walks the practice also facilitated weekly patient led walks. The GPs encouraged the activity with their patients to promote healthier lifestyles.

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 Beehive Surgery on 15 June 2017. The overall rating for the practice was inadequate. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Beehive Surgery on our website at www.cqc.org.uk.

The inspection of 15 June 2017 resulted in a warning notice being issued against the provider.

On 22 August 2017 we issued a warning notice to the provider in relation to a breach of Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good governance. We required the practice to become compliant with Regulation 12 by 31 October 2017.

The rating awarded to the practice following our full comprehensive inspection on 15 June 2017 remains unchanged. The practice will be re-inspected in relation to their rating within six months of the report being published from the June 2017 inspection.

This inspection was an announced focused inspection carried out on 3 November 2017 to confirm that the practice had met the requirements of the warning notice.

At this inspection we found that all aspects of the warning notice had been met.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection June 2017 – Inadequate).

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

Significant imporvements had been made since our first inspection on 15 June 2017. At that inspection the practice was rated inadequate and placed into special measures. Warning notices were issued in relation to regulatory breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). We carried out a further inspection on 3 November 2017 to check the warning notices had been complied with. We found significant improvements in both these areas. These reports can be viewed by selecting the ‘all reports’ link for Beehive Surgery on our website at www.cqc.org.uk.

The practice had carried out a full review of their processes since June 2017 and engaged with the clinical commissioning group (CCG) and the Royal College of General Practitioners (RCGP) with a view to embedding their new processes. There had been changes in personnel and the current personnel had been involved in making the improvements.

This announced comprehensive inspection at Beehive Surgery was carried out on 28 February 2018. This was a full follow-up inspection to check the required improvements had been made throughout the practice.

At this inspection we found:

• Significant improvements had been made throughout the practice. There had been some personnel changes and all remaining and newly recruited staff had been involved in discussions around the improvements required.

• Following the inspection on the 15 June 2017 the practice enrolled in the Royal Collage of General Practitioners (RCGP) special measures peer support programme. The programme involves a six month support package, working closely with the practice’s clinicians and senior staff to develop improvement solutions, provide peer support and in depth reviews and solutions for services.

• The practice had improved their process for recognising, recording and investigating significant events. They were discussed in meetings and learning was documented.

• The practice had systems in place to manage all aspects of safety. A fire risk assessment had been carried out, regular checks were performed and recorded and new fire extinguishers had been installed.

• Training for staff was well-monitored. There was a role-specific induction process for staff, including locum staff. Appraisals were up to date.

• The practice had carried out training in consent, the Gillick competence and the Mental Capacity Act 2005. It had updated its website so it no longer stated patients under the age of 16 must be accompanied by an adult.

• The complaints system had been reviewed. All complaints were investigated and appropriately responded to. They were discussed in meetings and lessons learned were documented.

• The practice had addressed issues around waiting times in the surgery. There was a break in appointments each hour in case surgeries were running late, and patients had commented that they had noticed an improvement.

• The practice routinely 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.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw an area of outstanding practice:

• Patients at the practice participated in monthly health walks from the practice led by the health trainer who was employed by the clinical commissioning group (CCG). To maximise the impact for patients, particularly female patients, the practice facilitated weekly patient led health walks. The practice displayed the walking route in the waiting area, and indicated where patients could join the walk if a different starting point was easier. The GPs encouraged the activity with their patients to promote healthier lifestyles.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice