This practice is rated as requires improvement overall. (Previous rating 14/12/2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Leyland Surgery on 19 June 2018 in response to concerns.

At this inspection we found:

• The practice did not always have clear systems to manage risk so that safety incidents were less likely to happen. The risk of a backlog of patient information that had not been viewed by GPs or entered onto patient records had not been assessed.
• Learning and actions taken in response to incidents was not always consistent.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system difficult to use and reported that they were not always able to access care when they needed it.
• Patients found it difficult to get through to the practice by phone.
• Governance arrangements were not being operated effectively to ensure the delivery of high quality, sustainable care.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

The areas where the provider should make improvements are:

• Improve the monitoring of emergency medicines in the practice.
• Consider the regular review of all children and young people on the practice safeguarding register.
• Develop a summary of significant events to identify any trends in events.
• Continue to improve arrangements for the identification of carers in order to offer them support where needed.

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

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Leyland Surgery on 14 December 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• There was a comprehensive quality improvement programme and the practice held regular clinical consistency meetings to ensure high levels of clinical practice.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. The practice organised and co-ordinated training for its own local federation of practices.
• The practice was proactive in its approach to patient care and had led on appointing a GP to work across the local federated practices to provide sessional support.
• 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.
• 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 held regular awareness days for patients to promote patient awareness of practice services and local support organisations.
• 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.
• The practice was forward-thinking and had developed a risk register to identify future risks to service delivery and to plan for the future.
• The practice was a training practice and provided support and mentorship to medical students and GP trainees at different stages of their learning. They had won a Quality Teaching Practice Bronze Award for year-four students in 2016 and had won silver awards in 2014 and 2015.

We saw two areas of outstanding practice:

• The practice offered a point of care service for blood monitoring for patients who were taking blood-thinning medications for heart conditions. This service allowed for patients to be monitored, assessed and issued with an appropriate prescription all at the one appointment or home visit. This avoided delays in the issuing of prescriptions to patients and reduced the administration associated with the monitoring process.

• The practice had piloted a new multidisciplinary team (MDT) service for vulnerable patients in 2013. They had identified the most vulnerable patients on the practice list and then worked with a team of professionals from health and social care to address those patients’ needs. They identified 36 patients for this pilot project who had had 146 documented contacts over the last three months with local health services and 19 unplanned admissions to hospital. They then worked with these patients and the MDT and reduced the number of contacts over the next three months to 50 with eight unplanned admissions to hospital. After a further three months, the number of contacts had been reduced to 19 with only two hospital admissions. The practice had continued to see positive results and we saw two case studies which demonstrated this. In September 2016, the clinical commissioning group recognised this ongoing work and the lead practice GP won a Research and Innovation award for their work and achievement with this service.

The areas where the provider should make improvement are:

• Review the protocol for GPs viewing communications received by the practice to ensure that only appropriate items are filed immediately by administration, and maintain an audit process to ensure compliance with the protocol.
• Improve compliance with the practice protocol for recording the use of prescriptions on prescription pads.
• The practice should continue to improve the identification of patients who are also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice