Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Burnley Wood Medical Centre on 23 September 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 incidents and near misses. Information about safety was recorded, monitored and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles.
• 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 were complimentary about the overall quality of service.
• Routine planned and urgent appointments were available the same day. The practice offered telephone consultations also.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Successful and productive working relationships were established with the health visitor and midwife to the benefit of patients.
• 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 was good awareness of where the practice needed to improve the services it provided and plans (although not always recorded) were implemented successfully to address these areas.

We saw areas of outstanding practice including:

• The practice was the driving force in promoting a joint initiative with the local public health department, and local community services including charities and faith groups to establish the Burnley Wood Health Hub. The vision of which was to be a resource to promote and support the best health outcomes for the local community.

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

Importantly the provider should:

• Ensure a periodic analysis of complaints and significant events is carried out to identify themes and trends so that appropriate action can be taken if required.
• Ensure the practice’s vision is recorded and aligned with a business development plan to clarify the purpose and direction of the GP practice and assist the practice team’s understanding of what needs to be done to achieve its aims and objectives.
• Ensure full practice team meeting are held periodically to provide opportunities for information sharing, reviewing issues and organisational goals and priorities and to facilitate learning and development.
• Ensure a planned programme of clinical and internal audits is established to enable the practice to monitor quality consistently and to make improvements as required quickly.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Burnley Wood Medical Centre on 9 January 2019 as part of our inspection programme. The practice had previously been rated as good overall and good for all population groups when we last inspected in September 2015.

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:

• 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.
• Clinical audit and other work undertaken by the practice demonstrated quality improvement.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• There was a strong team ethos amongst staff. Staff told us they felt supported by the practice leadership.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• The practice was proactive in ensuring military veterans received the support they needed; when health issues they experienced were related to their time in service we saw any necessary referrals were prioritised.

We saw an area of outstanding practice:

• The practice had previously led the development of the Burnley Wood Community Assets Projects to bring together a wide range of local services and promote closer joint-working and improve health and well-being outcomes for patients in the area. We saw work on these projects had been maintained, with new projects recently commenced.

Whilst we found no breaches of regulations, the provider should:

• Formalise and record processes to gain assurance workflow systems are operating as intended and non-medical prescribers are working within levels of competence.
• Complete a risk assessment to record the rationale for emergency medicines stocked by the practice and review stock held in regard to activities carried out.
• Review complaint response letters to include details of how patients can escalate their complaints should they be unhappy with the practice’s reply.

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