Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Buckshaw Village Surgery on 22 December 2016. 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 although actions taken as a result of these events were not formally reviewed.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Risks to patients were assessed and well managed although the practice did not always have sight of risk assessments or checks done on their behalf by the building management company.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice maintained high standards of infection prevention and control and audited these standards regularly. Actions were taken to address any improvements indicated although these actions were not always documented.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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 good governance arrangements in relation to having an overview of staff training, medical indemnity and membership of professional bodies although this overview was occasionally lacking in relation to locum GPs’ safeguarding training.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice:

• The practice organised clinical education events on a Saturday every two months for GPs in the local area. Training was delivered by invited clinicians and was free of charge for attendees. On average, 27 clinicians attended each event. We saw examples of positive feedback for these events and evidence of improvements to local procedures and better communication between clinicians as a result.
• The practice worked closely with a local retirement community of 236 apartments which was based in premises which the practice had partly occupied for two years from 2009 to 2011. The practice kept one of the rooms that it had previously occupied and ran two clinics a week from there for these patients and also provided “ward rounds” for patients unable to come to the clinics. Feedback from the community praised the surgery for its patient-centred approach to care and the positive effect that the service had had for those residents.
• In 2012 and 2013, the practice had developed the use of a computer tablet that gave clinicians mobile access to the patient computer record system. This tablet could be used during patient home visits and when away from the surgery premises. The practice subsequently shared this initiative with the clinical commissioning group who recognised the benefits of this, piloted the system in 2014 and then supplied 120 tablets to 64 other local practices for this purpose in 2015.
• The practice offered a daily point of care service for blood monitoring for patients who were taking blood-thinning medications for heart conditions. This service used new technology attached to the practice mobile tablet and in house computer system so that patients could be monitored, assessed and issued with an appropriate prescription all at the one appointment or home visit. This avoided delays in the issuing of prescriptions to patients and reduced the administration associated with the monitoring process.
• The practice worked with a local care home service for patients who were experiencing the effects of neurological damage or conditions. They visited the service twice a week and provided care for residents and support and training for staff at the home. The practice told us that inappropriate admissions to hospital for these patients had been reduced over the time of their involvement and recent audit showed that over 95% of admissions for these patients were appropriate. Feedback from the service manager confirmed that the surgery intervention had been instrumental in this and detailed improvements in wellbeing for residents.

The areas where the provider should make improvement are:

• Put systems in place to review actions taken as a result of significant events to ensure that they were effective.
• Maintain an oversight of premises risk assessments and checks carried out by the building management company.
• Improve the documentation of actions taken to address concerns identified by infection prevention and control audits.
• Carry out the same oversight of safeguarding training for locum GPs as for GPs in the practice.
• The practice should continue to improve the identification of patients who are also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Buckshaw Village Practice is situated in the newly developing Buckshaw Village complex on the outskirts of Chorley. Whilst we were at the practice we observed staff interacting positively with patients. During our visit we spoke with five patients and they all provided us with very positive feedback. Care was described by all the patients we spoke with as being of a high standard. Due to technical issues the date in the 'how we carried out this inspection' is incorrect. We conducted this inspection on the 12 June 2013.

Patients we spoke with told us they felt safe receiving care and support from the staff at the practice. The patients we spoke with all told us they were more than happy with the level of cleanliness. Their comments included, "It's a new building you'd expect it to be" and "It's brand new for a kick off so that helps". There were adequate disabled facilities and all treatment/consulting rooms were on the same level. All rooms were lockable and there was appropriate screening to maintain a patient's dignity and privacy whilst being treated. All the patients we spoke with all told us they had never had any cause to complain but felt that staff would listen to them and deal with any concerns appropriately. When we spoke with one of the GPs they told us, "I think we have an excellent team who are competent and qualified. All have good communication skills and I feel patients are being listening to. We have a good IT system which is used to its full potential."