This practice is rated as Good overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Marybone Health Centre on 17 October 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• 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 easy to use and reported that they were able to access care when they needed it.

• The practice had arrangements to ensure that facilities and equipment were safe and in good working order.

• 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.

• Staff worked well together as a team, knew their patients well and all felt supported to carry out their roles.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

• The practice had an active Patient Participation Group (PPG) who worked closely with staff to monitor and develop services.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice:

• The practice had the support of a Diabetic Specialist Nurse Consultant who was employed to coordinate and streamline care for students and complex diabetic patients. The nurse worked across a number of the Brownlow Health practices. At Marybone Health Centre the nurse provided added support to newly arrived students, who had type one diabetes. Patients were contacted and invited to register at the practice. For patients with complex needs the nurse would contact their previous GP to ensure all required treatments were in place. We found the nurse also provided personalised support via email and mobile number access. These examples had a very positive impact on ensuring continuity of care and on improving patient outcomes so that a transfer of care could be coordinated safely and effectively.

• The practice had a senior GP who worked closely with YPAS (Young Person’s Advisory Service) attending monthly meetings with a multi-disciplinary team working for children and young people. Some of this work involved developing and supporting patients with transgender needs. The practice had a Transgender Management Protocol to support GPs when prescribing. Staff had completed specialist training to ensure they understood and could respond sensitively to the needs of this population group. Staff we spoke with were aware of the risks for this population group and were responsive in the way their care was approached. We were told that patient referral to specialist support services and gender clinics were made direct to avoid delays. This resulted in improved waiting times for patients. The practice completed an assessment of risk for each patient and this was maintained at each stage of transition. Robust systems were in place to monitor the prescribing of medicines and patient care plans, evidence was provided after the inspection of the audits that were completed to achieve this.

The areas where the provider should make improvements are:

• Develop an inventory of equipment in use.

• Improve the action planning process following completion of risk assessments, audits, incident and complaints reporting.

• Should review and monitor the outcomes of the action plans to improve the practice children’s immunisations and cervical screening rates for patients.

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.