Letter from the Chief Inspector of General Practice

We undertook an inspection of Gorse Hill Medical Centre on 29 January 2015 as part of our new comprehensive inspection programme. The practice has a branch practice, Ayres Road Surgery, which we also visited during this inspection. We looked at how well the practice provided services for all population groups of patients. The inspection took place at the same time as other inspections of GP practices across the Trafford Clinical Commissioning Group.

Overall the practice is rated as requiring improvement.

Our key findings were as follows:

• Care was provided in an environment which was clean and organised.

• There was a nominated GP lead for the safeguarding of adults and children. Systems were well established to safeguard children and adults.

• Care plans were in place for patients who were older or had multiple complex conditions which could increase the risk of unplanned hospital admissions or attendance at accident and emergency.

• Patients were positive about their overall experience of making appointments

• The Patient Reference Group were complimentary about the responsiveness of the practice when acting on comments or complaints.

• Patients said staff were caring and always helpful

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

Importantly, the provider must:

• Ensure there is effective medicines management in place. Emergency drugs must be available and effective checks on expiry dates of medicines must be undertaken.

• Ensure that staff have access to emergency equipment, with appropriate policy guidance in place

• Ensure staff are safely and effectively recruited and employed by undertaking appropriate recruitment checks and maintaining comprehensive staff files.

• Ensure systems are in place to verify the registration of all clinical staff with their professional bodies.

• Ensure staff have annual documented appraisals, with identified personal development plans.

In addition the provider should

• Provide additional training on the practice’s electronic records system

• Provide appropriate training for staff on the Mental Capacity Act (2005

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Gorse Hill Medical Centre was led by three GP partners with a practice population of 5700 patients. Additional to the three GP's, there was a nurse practitioner, nurse, receptionists and administration staff.

Patients told us: “I’m happy to see any GP, you get an appointment quickly,” “The staff have been here a long time, you know them and they know you. It’s nice to have continuity,” and "If I was to give them a score it would be 11 out of 10."

All members of the staff we spoke with understood the principles of obtaining consent, including issues relating to capacity.

Patients we spoke with confirmed they had time to discuss their concerns during the consultation and that treatment was fully explained to them.

Within the five patient records we checked, we found consultations included details about the assessments carried out and any treatment required, including tests and referral to other services.

The staff were able to demonstrate clear understanding of their roles and responsibility to safeguard patients.

All areas of the practice were clean, tidy and well maintained. One patient told us: “It’s always nice and clean here, I’m a cleaner so I notice these things.”

Systems were established to identify, assess and manage risks related to the service provided through a series of internal checks and audits.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the practice of Gorse Hill Medical Centre on 14 December 2016. Overall the practice is rated as good.

The practice had been previously inspected on 29 January 2015. Following that inspection the practice was rated as requires improvement with the following domain ratings:

Safe – Requires Improvement

Effective – Requires improvement

Caring – Good

Responsive – Good

Well led – Requires improvement.

The practice provided us with an action plan detailing how they were going to make the required improvements.

The inspection on 14 December 2016 was to confirm the required actions had been completed and award a new rating if appropriate.

Following this re-inspection on 14 December 2016, our key findings across all the areas we inspected were as follows:

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.
• Risks to patients were assessed and well managed, including those relating to recruitment checks.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Data showed patient outcomes were mixed compared to those locally and nationally.
• Feedback from patients about their care was strongly positive,

• Patients said they were in the main treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a result of feedback from patients.

• Information about services and how to complain was available and easy to understand.

• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

• 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.

We saw examples of outstanding practice including:

• The practice embraced Gold Standards for end of life care. One GP took the lead and provided weekly home visits to support and monitor patients at the end stages of life. Families also had direct contact details for GPs should they require support and or additional home visits. Speaking with one patient who was recently bereaved told us how invaluable the relationship with the GP had been.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice