This practice is rated as Good overall. (Previous inspection March 2018 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced focused inspection at Greengate Medical Centre on 6 November 2018. The inspection was carried out to follow up on a breach of regulations identified at our inspection in March 2018. At that inspection the rating for the key question of well led was requires improvement. During this inspection we looked at the key questions of safe and well led.

At this inspection we found:

• The system and processes in place to maintain the cold chain had been fully reviewed and were now operating effectively.
• The storage of equipment and medicines had been reviewed and rationalised and medicines and equipment were readily accessible if required in an emergency.
• Recruitment information was now readily available in staff files and assurance gained that all necessary employment checks had taken place, including in respect of locum GPs.
• The system for maintaining oversight of staff training had been improved and all training was now up to date.
• Practice policies had been reviewed and the practice acted in accordance with their policies.
• Information about the complaints process was readily available to patients.
• The mitigating actions identified by means of risk assessment were being followed.
• Systems and processes within the practice were operated effectively. Governance arrangements maintained oversight of all areas.

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

This practice is rated as Good overall. (Previous inspection August 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced inspection at Greengate Medical Centre on 13 March 2018 as part of our inspection programme.

At this inspection we found:

• There was an effective system in place to deal with safeguarding and staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.

• There were processes for handling repeat prescriptions which included the review of high risk medicines.

• We found that the system to maintain the cold chain was not operating effectively as refrigerators used to store vaccines did not have a secondary thermometer in place and there had been issues with temperature recording. The refrigerators had not been serviced annually. The practice took action on the day of inspection to rectify this.

• We found that the storage of equipment and medicines would benefit from being rationalised to avoid a delay in accessing medicines or equipment required in an emergency.

• Not all recruitment information was available in staff files and therefore there was no assurance that all necessary employment checks had taken place, particularly in respect of locum GPs. The practice told us following the inspection that this was being addressed.

• Staff told us they had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However, there were some gaps in training and the practice had an action plan in place to address this. Staff had received appraisals in the last 12 months.
• Results from the national GP patient survey 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, although this had to be requested from a receptionist. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients commented that they were pleased with the care they received and were able to get appointments when they needed them.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure whereby staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• The practice had a range of practice specific policies but we found some examples where the practice had not acted in accordance with their own policies.

• Not all systems and processes within the practice were operated effectively. Governance arrangements were in place but some areas identified during our inspection indicated a lack of oversight.

The areas where the provider must make improvement are:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. More detail can be found in the requirement notice section at the end of this report.

The areas where the provider should make improvements are:

• Ensure information about the complaints process is readily available to patients.

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 Greengate Medical Centre (Dr RG Ackerley and Partners) on 12 August 2015. Overall the practice is rated as good.

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

• Information about safety was recorded, monitored, appropriately reviewed and any issues were addressed in a timely way. There was an effective system in place for reporting and recording significant events and complaints.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• 60% of patients said they found it easy to make an appointment with a named GP and that there was continuity of care.
• Urgent appointments were available on 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice