We carried out an announced focused inspection at Denton Turret Medical Centre on 11 January 2019. This was as part of our ongoing inspection programme and to check the practice had made the improvements CQC said they should when we last inspected the practice in April 2018.

At the last inspection in April 2018 we rated the practice as requires improvement for providing safe services because:

• Improvements were needed to ensure the practice had adequate systems to assess, monitor and manage risks to patient safety.
• Their approach to learning from incident and near misses was limited as not all staff were supported and encouraged to identify incidents that the practice could learn from.

At this inspection, we found that the provider had satisfactorily addressed these areas.

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 rated this practice as good overall. (Previous rating April 2018 – Good). We rated the practice as good for providing safe services because:

• They had implemented a record of staff immunity levels for mumps, chickenpox and rubella in line with national guidance.
• They had carried out test fire evacuations.
• They had improved their approach to identifying and learning from significant events.

In April 2018, we told the provider they should continue with the planned programme of staff appraisals to ensure all staff benefit from these support meetings at least annually. In January 2018, we found all staff employed for over a year had received an appraisal within the last year.

We also told the practice in the April 2018 inspection that they should review the arrangements for encouraging and acting upon feedback from the patient participation group. We spoke with members of the current group, who told us they were satisfied with the arrangements in place and the practice responded to and acted upon their feedback. The group was small (with three members) and the practice manager told us they had taken action to encourage new members to join, but no new members had yet come forward.

In April 2018, we also noted the practice was slightly lower on their satisfaction scores within the National GP Patient Survey (published July 2017) on consultations with GPs and nurses. However, they were not a statistical outlier on these indicators. In the survey results published in July 2018, the practice was still slightly lower than average on indicators relating to how doctors and nurses provide services with kindness, respect and compassion (National GP Patient Survey data published July 2018). As in the previous year, the practice was not a statistical outlier for these indicators. For example:

• The percentage of respondents to the GP patient survey who stated that the last time they had a general practice appointment, the healthcare professional was good or very good at listening to them was 83.5% (CCG average 91.3%, England 89.0%).
• The percentage of respondents to the GP patient survey who stated that the last time they had a general practice appointment, the healthcare professional was good or very good at treating them with care and concern was 79.7% (CCG average 90%, England 87.4%).
• The percentage of respondents to the GP patient survey who stated that during their last GP appointment they had confidence and trust in the healthcare professional they saw or spoke to was 93.1% (CCG average 96.6%, England 95.6%).
• The percentage of respondents to the GP patient survey who responded positively to the overall experience of their GP practice was 83.8% (CCG average 87%, England 83.8%).

The practice told us they were encouraging clinicians to fully engage patients in discussions about their health. Clinicians recorded this on the patient record. The practice told us they had carried out analysis of this, which showed the number of times clinicians had recorded ‘shared decision making’ during a consultation had increased from 24 for the year to 30 September 2018 to 311 by end of December 2018. The practice had not carried out their own survey of the views of patients to check if those improvements had yet impacted on patient satisfaction levels.

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 a planned comprehensive inspection of Denton Turret Medical Centre on 18 December 2014.

Overall, we rated the practice as good. We found the practice to be good for providing safe, effective, caring, responsive and well-led services. Our key findings were as follows:

• The services had been designed to meet the needs of the local population.

• Feedback from patients was positive; they told us staff treated them with respect and kindness.
• Staff reported feeling supported and able to voice any concerns or make suggestions for improvement.
• The practice was visibly clean and tidy.
• The practice learned from incidents and took action to prevent any recurrence.

We saw an area for improvement:

The practice should ensure that all staff undertake annual fire safety training.

We saw the following areas of outstanding practice:

The partners had employed a new practice manager and tasked them with modernising and improving the practice. They also supported the practice manager’s commitments with the CCG. Those actions have benefited the practice. For example, the practice has completed a re-structuring of the administrative teams and refurbishment of part of the building and Phase two is to be planned. Through the practice manager the practice had representation at board level in the CCG which enabled them to discuss practice based and wider issues affecting the provision of primary care services.

The practice had introduced the Denton Turret Practice Champions (These are patients of the practice who had volunteered to help promote health and wellbeing of patients) These patients worked closely with the practice manager and GPs to improve the way services were delivered. They provided information for other patients and signposted them to local health support groups.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection December 2014 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Denton Turret Medical Centre on 4 April 2018. This was as part of our ongoing inspection programme.

At this inspection we found:

• The practice had clear systems to keep people safe and safeguarded from abuse.
• Improvements were needed to ensure the practice had adequate systems to assess, monitor and manage risks to patient safety.
• Their approach to learning from incidents and near misses was limited as not all staff were supported and encouraged to identify incidents that the practice could learn from.
• The practice routinely reviewed the effectiveness and appropriateness of the care they provided. They 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.
• Leaders had the capacity and skills to deliver high-quality, sustainable care.
• The practice involved patients, the public, staff and external partners to support high-quality sustainable services. However, the practice was not always effective at engaging with the patient participation group to ensure the voices of patients were listened to and acted upon.

The areas where the provider should make improvements are:

• Review the processes for identifying significant events and near misses to encourage staff to identify a wider range of these that the practice could learn from.
• Keep a full record for staff of their immunity level for measles, mumps, chickenpox and rubella in line with The Green Book Immunisation against infectious disease.
• Carry out regular fire evacuation tests in line with their own fire risk assessment.
• Continue with the planned programme of staff appraisals to ensure all staff benefit from these support meetings at least annually.
• Review the arrangements for the patient participation group to encourage and act upon feedback from the group.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice