Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Drs Blacklidge, Green & Jackson (Great Ayton Health Centre) on 5 October 2016. Overall the rating for the practice was requires improvement (safe was rated as inadequate, effective and well led rated as requires improvement and caring and responsive as good).

We carried out a further comprehensive inspection at Drs Blacklidge, Green & Jackson (Great Ayton Health Centre) on 22 May 2017 to check whether the practice had made the required improvements. The overall rating for the practice following this inspection was good

During the inspection on the 5 October 2016, we found the following areas of concern:

• Systems, processes and practices were not always reliable or appropriate to keep people safe. There were some concerns about consistency of understanding of the practice management in respect of these areas. We found concerns relating to a number of areas, mainly the management of significant events, safeguarding, medicines management, recruitment of staff and the practices ability to respond to an emergency.

• The practice did not have systems in place to ensure mandatory training was completed by all staff. We identified staff that had not completed training in a range of areas that included: safeguarding, fire safety awareness, basic life support and information governance.
• The arrangements for governance did not always operate effectively. The practice was not aware of some of the risks and issues we identified or was aware and had not acted on them.
• The partners demonstrated a commitment to their wider clinical roles and interests in the community which were of benefit to the practice. However, their prolonged absence from the practice caused some concern regarding the impact on the leadership arrangements when they were absent for significant periods of time.

As a result of our findings at this inspection we issued the provider with five requirement notices for the Safe care and treatment, Safeguarding service users from abuse and improper treatment, Good governance, Staffing and Fit and Proper Persons Employed.

Following the inspection on 5 October 2016 the practice sent us an action plan that explained what actions they would take to meet the regulations in relation to the breaches of regulation we identified.

We carried out a further comprehensive inspection at Drs Blacklidge, Green & Jackson (Great Ayton Health Centre) on 22 May 2017 to check whether the practice had made the required improvements.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey were above the national averages for the way patients were treated. They showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was above national averages. Patients we received feedback from 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.
• A new overarching governance framework which supported the delivery of the strategy and good quality care had been put in place.
• There was a focus on continuous learning and improvement at all levels within the practice. The practice management demonstrated they had acted on the findings of the previous inspection and had taken action to address the issues identified. Whilst many of these changes were in their infancy it was clear the practice was on an improvement trajectory both within the practice itself and in engaging outside of the practice with the likes of the CCG and other local practices. They demonstrated they had put governance arrangements in place to ensure that the new changes introduced were embedded into practice over time.

However there were areas of practice where the provider should make improvements:

• Review the system for recording refrigerator temperatures and ensure that medicines which are no longer required by patients are disposed of in a timely way.
• Ensure any personal clinical equipment used within the practice is identified and calibrated.
• Consider the frequency of the checking of emergency equipment and medicines at the practice to ensure that it identifies out of date medicines or faulty equipment in a timely way.
• Review the system that identifies patients who are also carers to help ensure that all patients on the practice list who are carers are offered relevant support if appropriate.
• Ensure planned appraisal for nursing and non-clinical staff take place.
• Consider the arrangements in respect of the Accessible Information Standard. The Standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read and understand and with support so they can communicate effectively with health and social care services.
• Ensure the improvements made are monitored and embedded into practice to ensure their

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Blacklidge, Green & Jackson (Great Ayton Health Centre) on 5 October 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• The practice reported, recorded and reviewed significant events. However the practice did not have a formal system in place for this which resulted in an inconsistent approach to recording. The practice carried out a thorough analysis of each significant event and evidenced changes as a result. However, there was no documentary evidence to show that if changes had been made following an event that these had been revisited over time to ensure the changes were effective and embedded within the practice.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• There was evidence of quality improvement including clinical audit. Patients were supported to live healthier lives.
• GPs at the practice had a wide skill mix with a range of roles outside of the practice.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.
• 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.
• The practice had some governance arrangements in place.
• The practice did not have a patient participation group (PPG).
• Staff told us they were supported by the management and felt there was an open culture at the practice.
• There was evidence of clinical learning and improvement within the practice and some evidence for learning in some non-clinical areas. The practice team was forward thinking and part of local pilot schemes to improve outcomes for patients in the area. The practice partners demonstrated a commitment to the involvement in the local community.

The areas where the provider must make improvements are:

• Ensure robust processes are in place for all aspects of medicines management.
• Implement robust safeguarding processes.
• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Take action to ensure the practice can respond to an emergency on the premises.
• Take action to address gaps in the mandatory training completed by staff. Implement a system for monitoring the completion of all required training.
• Implement robust governance arrangements to enable the provider to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk.
• Ensure there is leadership capacity to deliver all improvements.

The areas where the provider should make improvement are:

• Take action to ensure policies and procedures are regularly reviewed and updated.
• Take action to ensure a programme of clinical and non-clinical audit is in place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice