We carried out an announced comprehensive inspection at Garstang Medical Practice on 19 December 2018 as part of our inspection programme. Our inspection team was led by a CQC inspector and included a GP specialist advisor a nurse observer and a CQC inspection manager.

At the last inspection published in October 2014 we rated the practice as good overall.

Our judgement of the quality of care at this service is based 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.

The practice is rated as good overall.

We rated the practice as good for providing safe, effective,caring, responsive and well-led services because:

• Patients had good outcomes because they received effective care and treatment that met their needs.
• People who used the service were generally protected from avoidable harm and abuse, however management of emergency medicines and fire procedures were not always safe.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• Patients’ needs were met by the way in which services were organised and delivered.
• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care.

There were areas where the provider

should

make improvements:

• Improve the management of significant events and include dispensary errors.
• Review information provided to complainants when complaints might not be resolved to their satisfaction.
• Review recruitment procedures and requisite information retention.
• Consider review of the signage and access around the building.
• Review fire safety procedures, particularly evacuation of the premises.
• Review procedures for checking emergency medicines.
• Update procedures for recording blood tests for patients prescribed higher risk medicines.

We saw two areas of outstanding practice including:

• Sufficient urgent appointments were provided each day, linked to demand. The impact of the utilisation of advanced nurse practitioners and pharmacy team had led to a significant reduction in the volume and unpredictability of unscheduled work. We were told this resulted in less pressure and stress for patients and staff.
• The community nurse practitioner employed by the practice had led to an improved, coordinated approach to delivering care in a rural community. They chaired a group of members of staff from local health, social care and public services, working together to provide care and support for the local community.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Windsor Surgery was inspected on the 1st October 2014. The inspection was a comprehensive inspection under our new approach methodology.

Windsor Surgery provides services that include access to GPs and nursing staff for diagnosis and treatment of conditions and illness, minor surgical procedures and ante and post natal health care for mothers and their babies.

The practice worked effectively to reach good outcomes for patients, improve the quality of the patients’ lives and worked within the most up to date guidance including developing some innovative approaches to better meet the needs of the patients using the practice.

Our key findings were as follows

• The practice had improved year on year on the things that are important to patients including

  1. Patient access to a range of appointment types
  2. Patients receiving an appointment in an emergency situation on the same day.
  3. Patients getting through on the phone
  4. The practice had an ever growing Patient Participation Group that took an active role in developing and improving patient services.
  5. The practice had systems in place to protect patients from infection and maintain a clean environment.
  6. The practice staff received training in excellent customer care and we witnessed staff being respectful and polite to patients at all times.

We saw areas of outstanding practice including:

• The practice adopting the principles of the ‘Better Care Together’ strategy and working in a cohesive way with community services to better meet the needs of the patients.
• A number of meetings took place weekly to continuously improve how the practice delivered services to the patients. Many of these meetings included external professionals and invited patients as appropriate.
• A GP mentoring programme was in place to support GPs returning from long term leave of absence. The programme worked around the needs of the GP and lasted for as long as they wanted the additional support.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

We spoke with six people who used the service (patients) and they all provided us with very positive feedback. All the patients told us they felt safe when receiving care and support and staff were friendly and caring. They all stated that the service they received was of a high standard. One patient told us, "For me the service here is excellent. Every time I ring I get to see someone the same day. I feel I have enough time with the doctor or whoever I have come to see. I'm always happy". Another patient told us, "I've always come out from seeing the GP feeling they have helped me".

An up to date 'Cleanliness and Infection Control' policy was in place for the practice. This covered a number of areas including, premises cleaning, clinical waste management, control of substances hazardous to health (COSHH), hand washing and single use instruments.

Staff told us they felt supported and were able to raise issues with peers or management. There was evidence staff training took place on a regular basis.

During our visit we found the practice had systems to assess and monitor quality. This included regular audits, staff meetings and patient satisfaction surveys.