Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection at Castlecroft Medical Practice on 12 December 2014. The practice is registered with the Care Quality Commission to provide primary care services to its local population. This is the report of the findings from our inspection.

We have rated each section of our findings for each key area. The practice provided an effective, caring, responsive and well led service for the six population groups it served but required improvement to provide a safe service. The overall rating was good and this was because the practice staff consistently strived to provide a good standard of care for patients.

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, appropriately reviewed and addressed.
• Infection prevention and control systems were well managed and staff had received appropriate training. Lead roles had been assigned to manage infection control and staff were aware of who held the lead role.
• The practice was proactive in measuring and monitoring risks to patients and services provided. Risks identified were discussed at practice meetings and evidence was available to demonstrate that necessary action had been taken where risks were identified.
• Systems were in place to review the care needs of those patients with complex health needs or those in vulnerable circumstances. Patient care co-ordinators at the practice made regular contact with these patients to help ensure that they attended routine health checks and immunisations.
• Patients said that the GPs listened to what they had to say and treated them with compassion, dignity and respect. Patients told us that they were involved in their care and decisions about their treatment.
• Patients reported good access to the service; those patients who required an urgent appointment were given an appointment on the same day that they telephoned. Those patients who were hard of hearing were able to email requests for urgent appointments. Patients were able to book and cancel appointments on-line, by telephone or by visiting the practice.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.
• The practice manager, business manager and GP partners were responsible for monitoring and review of systems and practices with the aim of continuous improvement. These management staff were aware of areas that required improvement and had identified action to be taken to address these issues.

• There was an open culture within the practice and staff were actively encouraged to raise concerns and suggestions for improvement. The practice philosophy and practice charter were available for patients. This document included information regarding access to the service, waiting times and complaints. The practice had a clear vision to deliver high quality care and good outcomes for patients. Staff demonstrated a person-centred approach and through discussions it was obvious that delivering high quality care to meet patient’s needs was of paramount importance.
• There was an active Patient Participation Group (PPG) who met on a regular basis. The PPG reported an excellent relationship with the practice and confirmed that the practice listened and acted upon suggestions made by them. Learning events requested by the PPG, which related to the needs of the practice population had been organised. One PPG member had been involved in the recent employment of the Business manager.

We saw the following areas of outstanding practice:

The practice provided a good range of nurse led clinics which supported the role of the GP. Patients with long term conditions were allocated to patient care advisors. Patient care advisors were responsible for ensuring that a robust system of patient calling for long term conditions was in place. Each member of the team had their own list of patients. Patients would be contacted by telephone and then letter. A system of recording contacts and attempted contacts with patients had been implemented.

The practice encouraged membership of their Patient Participation Group (PPG) through posters displayed in the waiting room and information on their website. The PPG met on a regular basis and received support with meetings from practice staff who also attended these meetings. Educational events were organised by practice staff for the PPG and recent events had included pain management, stroke and resuscitation training. Guest speakers had been invited to talk about the local alcohol services, a urology talk, eating disorders and dementia. Some of the guest speakers had been suggested by the PPG and some by the GP according to the needs of the practice population. The PPG confirmed that they were informed and involved in any changes at the practice. One of the PPG members had been involved in the recent employment of the Business Manager. PPG members had been invited to meet candidates prior to their interview and to give feedback to the practice manager and lead GP.

However, there were also areas where the practice should make improvements.

• Ensure that recruitment processes are followed so that information required under current legislation is obtained prior to employment.
• Ensure the appraisal system for nursing staff includes personal development plans.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice