Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Irlam Medical Practice. The practice is registered with the Care Quality Commission to provide primary care services.  

We undertook a planned, comprehensive inspection on 2 October 2014. We spoke with patients, staff and the practice management team.

The practice is rated as Outstanding. An innovative, caring, effective, responsive and well-led service is provided that meets the needs of the population it serves. Our key findings  are as follows:

The service is safe. There are systems in place to address incidents, deal with complaints and protect adults, children and other vulnerable people who use the service. Significant events are recorded and shared with multi professional agencies and there is evidence that lessons are learned and systems changed so that patient care is improved.

The service is effective. There are systems in place to support the GPs and other clinical staff to improve clinical outcomes for patients. According to data from the Quality and Outcomes Framework (QoF), which is the annual reward and incentive programme detailing GP practice achievement results, outcomes for patients registered with this practice are above average for the locality. Patient care and treatment is considered in line with best practice national guidelines and staff are proactive in promoting good health.

The service is caring. The practice are pro-active in obtaining as much information as possible about their patients including carer status, family dynamics, dependency and any other outside influences which do or can affect their health and wellbeing. All the staff know the practice patients very well, are able to identify people in crisis and are professional and respectful when providing care and treatment.

The service is responsive. The practice plans its services to meet the diversity of its patients. There are good facilities available, adjustments are made to meet the needs of the patients and there is an appointment system in place which enables good access to the service.

The service is well led. The practice has a clear vision and set of values which are understood by staff and made known to patients. There is a clear leadership structure in place, quality and performance are monitored and risks are identified and managed.

We saw areas of outstanding practice. For example :

• All the practice staff proactively follow up information received about vulnerable patients. We saw five examples where clinical and reception staff had used their initiative when they had raised a concern or passed on information which led to a positive outcome for the patient.

• The practice also reaches out to the local community. The practice nurses voluntarily carry out an annual stroke awareness clinic at a local supermarket for the whole community and have been doing this for the last five years.

• We saw excellent examples of close working partnerships with other health and social care professionals which includes care planning. Care Plans are in place for two per cent of the practice patients as part of a national enhanced service and with a view to avoiding unplanned admissions to hospital.

• Clinical audits are undertaken on a regular basis and results from those audits are used to improve the quality of services provided. An infection control audit checked that patients using nebulisers were educated in routine maintenance of their machines to reduce the risk of bacterial contamination and advice was reinforced during annual reviews of their care.

• Significant events are recorded and shared with multi-professional agencies in and outside the practice. We saw evidence that lessons are learned and systems changed so that patient care is improved.

• There is good leadership and a strong learning culture within all the staff who have a clear vision with quality and safety as their top priority. Staff respond to change and are encouraged to bring suggestions for improvement. We saw a high level of constructive staff engagement and staff satisfaction.

There were areas where the practice should improve. For example

• The practice did not pro-actively obtain and record feedback from patients about minor surgery and did not regularly encourage people to comment about their care and treatment.

Professor Steve Field CBE FRCP FFPH FRCGP                       

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Irlam Medical Practice 2 on 14 December 2018 as part of our inspection programme. The practice was previously inspected on 2 November 2014 and was rated in outstanding in all key questions.

We based our judgement of the quality of care at this service 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.

We have rated this practice as requires improvement overall and good for all population groups.

We rated the practice as requires improvement for providing safe services because:

• The practice did not always have clear systems and processes to keep patients safe. This included taking appropriate action on patient safety alerts and ensuring recruitment checks were documented when employing new staff members.
• The practice did not keep a signing out logbook of blank prescriptions being used.
• The practice did not have a fire risk assessment in place.

We rated the practice as requires improvement for providing well-led services because:

• The overall governance arrangements were lacking. For example, the system for monitoring staff training was ineffective and we found that some staff training had not been completed since 2014.
• The practice did not always have clear and effective processes for managing risks. For example, there was no policy in place for acting on patient safety alerts. We found some alerts that had been received by the practice, but had not been opened.
• The practice did not have a recruitment procedure in place.
  

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

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Patients received effective care and treatment that met their needs.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Formalise a policy for significant events.

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

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