We carried out an announced comprehensive inspection at Broseley Medical Practice on 11 December 2018 as part of our inspection programme. The practice was previously inspected in October 2014 and rated as good.

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 rated the service as requires improvement for providing safe services because:

• The practice did not have effective recruitment processes in place to keep patients safe and protected from potential harm.
• Clinicians knew how to identify and manage patients with severe infections including sepsis however, not all clinicians coded physiological data which would trigger the sepsis alert protocols within the practice clinical system.
• The process for ensuring patients received the necessary monitoring before high risk medicine was prescribed for them was not always effective when patients had shared care arrangements.
• There were few significant events recorded; this prevented effective improvement to the quality of patient care delivered from lessons learnt through events.
• Staff had access to training opportunities to support them in their work. However, some staff were not up to date with essential training in safe working practices.

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

• Patients received effective care and treatment that met their needs.
• The practice worked closely with outside agencies to improve the care delivered.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care. Staff felt that the benefits of working in a small team enabled them to be more patient orientated and provided opportunity to get to know their patients.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• Patients received effective care and treatment that met their needs.
• The practice’s uptake rates for childhood immunisation were above the World Health Organisation (WHO) 95% targets.
• The practice had experienced significant staff and recruitment challenges and as a result had reviewed and made changes to their workforce to meet the needs of their patient population.
• The practice was working collaboratively with other local practices to bring more flexible evening and weekend appointments to patients.
• The practice provided an in-house counsellor and had a community and care co-ordinator to help assist patients of any age in need of help, support and advice by offering a signposting service and support with social isolation.
• Regular meetings were held with staff to communicate to share information and practice performance.
• Leaders were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.
• There were clear responsibilities, roles and systems of accountability to support good governance and management and most staff felt supported by the management. However, there were areas where these needed to be strengthened.

The areas where the provider must make improvements are:

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

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review the significant events reporting and recording system to improve the quality of patient care from lessons learnt.
• Develop an effective system for the monitoring of high risk drug prescribing.
• Review how all staff complete outstanding essential training.
• Consider sharing current evidence based guidance in clinical meetings.
• Review and improve the quality of audits undertaken to drive quality improvement.
• Formulate an action plan for responding to the results of the national GP patient survey to include actions to address the lower than average results regarding access to the service
• Develop a documented business plan and strategy to support the practice’s aim to deliver high quality care and promote good outcomes for patients.
• Continue to strengthen governance arrangements.

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 inspected this service on 22 October 2014 as part of our new comprehensive inspection programme.

The overall rating for this service is good. We found the practice to be good in the safe, effective, caring, responsive and well-led domains. We found the practice provided good care to older people, people with long term conditions. families, children and young people, working age people, people in vulnerable groups and people experiencing poor mental health. One example of this was the practice employed its own counsellor to support patients with mental health problems such as depression or stress and anxiety.

Our key findings were:

• Performance was consistent over time and patients were kept safe because there were arrangements in place for staff to report and learn from incidents that occurred.
• Patients received evidence based assessments and care and treatment was planned and delivered to promote a good quality of life.
• Staff treated patients with kindness and compassion. Patients told us that staff were caring and treated them with dignity and respect. They said that they had confidence and trust in the GPs and nurses.
• Services were planned and delivered to meet the needs of the patients. Patients were positive about the access to appointments and the telephone consultation service.
• The leadership and management within the practice promoted an open and transparent culture. Staff felt able to contribute to the running of the service. The practice sought and acted on feedback from staff and patients.

There were also areas of practice where the provider needs to make improvements. The provider should:

• Ensure that the recruitment processes are in line with the practice’s own recruitment policy and that all staff have either a criminal records check via the Disclosure and Barring Service (DBS) or have a risk assessment in place to explain why a DBS check is not needed.
• Review the significant events reporting and recording system to ensure that all events that are critical (whether beneficial or detrimental to the outcome) are included and to improve the quality of patient care from the lessons learnt.
• Consider ways to strengthen the risk management processes within the practice to ensure that all risks are assessed and rated with mitigating actions recorded to reduce and manage risks, including those relating to legionella, fire safety, recruitment and electrical testing.
• Update the health and safety policies and procedures used by the practice to ensure that all requirements in the Control of Substances Hazardous to Health Regulations 2002 (COSHH) are met.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice