We spoke with three patients on the day and following our visit. They spoke positively about the practice and commented they were happy with the care they received.

The practice was adequately maintained, had disabled access at the front of the practice but did not have access to a disabled toilet.The practice manager informed us they were waiting confirmation of funding from the Care Commissioning Group to refurbish the premises.

The practice had electronic records in place to accurately describe the contact patients had with the service and the actions taken to provide appropriate care and treatment.

We found staff had access to contact details for both child protection and adult safeguarding teams. They were able to describe the appropriate actions they would take if they had any safeguarding concerns.

The practice had an up to date recruitment policy in place. We looked at five personnel files and found contracts in place and evidence of identification and qualification checks.

The practice had a range of policies and procedures in place for staff to access, which supported the safe running of the service.

The practice was a member of the local GP preventing infection together programme where they were able to access support for infection prevention and control (IPC). The nurse was identified as the lead for IPC.

A patient told us; "I moved out of the area and appealed when I was told I would have to move GP. I won so I can stay here. It is a great practice".

This practice is rated as Good overall. (Previous rating 21 October 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

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 Garnet Fold Practice on 20 November 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice reviewed the effectiveness and appropriateness of the care it provided.
• It 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.
• There was a responsive approach to feedback from patients.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• The practice should consider a risk assessment to verify the emergency drugs they have chosen to keep on the premises.
• The practice should consider introducing an up to date incident reporting policy and lower the threshold for formally raising incidents so that all incidents are discussed.
• The practice should consider formally recording when follow up actions have been completed for example those discussed at meetings or required following incidents.
• The practice should consider more structured meeting agendas where all staff are involved.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice