This practice is rated as Good overall. (Previous inspection November 2017 – inadequate and placed in special measures)

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

Significant improvements had been made since our previous full inspection November 2017. At that inspection the practice was rated inadequate and placed into special measures. Warning notices were issued in relation to regulatory breaches of Regulation 12 (Safe care and

treatment) and Regulation 17 (Good governance). We carried out a further focused inspection on 10 April 2018 to check the warning notices had been complied with. We found improvements in both these areas. These reports can be viewed by selecting the ‘all reports’

link for Medlock Vale Medical Practice on our website at www.cqc.org.uk.

The practice recruited a new management team who have carried out a full review of their processes since our inspection in November 2017 and were in the process of embedding their new processes and improving care and treatment for patients.

This announced comprehensive inspection at Medlock Vale Medical Practice was carried out on 9 August 2018. This was a full follow-up inspection to check the required improvements identified in November 2017 had been made throughout the practice.

At this inspection we found there were significant improvements made in all areas for example:

• The practice now 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 now routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence - based guidelines and medicines were being appropriately monitored and patients were being reviewed.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients noted the appointment system has improved and more appointments were available with GPs and nurses.
• We found the leaders now had the capacity and skills to deliver high-quality, sustainable care.
• There was now a strong focus on continuous learning and improvement at all levels of the organisation.

As a result of the improvements made the practice has been re rated and removed from special measures.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

On 14 November 2017 we carried out a full comprehensive inspection of Medlock Vale Medical Practice. This resulted in the practice being placed in special measures and Warning Notices being issued against the provider on 15 December 2017. The Notices advised the provider that the practice was failing to meet the required standards relating to Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Safe care and treatment and Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Good governance.

On 10 April 2018 we undertook a focused inspection to check that the practice had met the requirements of the Warning Notices. We found all issues had been addressed and improvements made to a satisfactory standard. In particular we found that :

• The practice is working with a GP consultant team to review and develop the governance and management team within the practice. We saw the relationship was newly developed but plans were in place to ensure clear governance systems and process had been prioritised.
• The practice introduced a new system for recording and reviewing significant events. We reviewed the details of two recent significant events and found these had been investigated with actions and outcomes documented and reviewed.
• The practice had introduced a new system to monitor, review and action where appropriate safety alerts and alerts received from the MHRA. We reviewed in detail two recent alerts and found these to be actioned appropriately. We also noted a new system to audit the alerts had been implemented.
• We saw the treatment room was now compliant with infection control standards after the flooring had been replaced.
• We saw a new policy and procedure was in place for the cold chain and speaking with staff and reviewing recent data from the cold chain data logger we were satisfied the cold chain was now being appropriately managed.
• Fire safety checks were being carried out and this now included emergency warning light checks.
• A new two week wait referral system had been introduced and was being monitored to ensure all referrals were completed and action taken where appropriate.
• A new pharmacist was in post as part of the GP consultant team and they were in the process of reviewing all patients who required medication reviews and we saw a clear timeline was in place for this to happen.
• There was an updated policy and procedure in place to ensure appropriate care and treatment was in place for patients prescribed lithium. We reviewed records and noted all checks were up to date and there was now a recall system in place.
• A new policy and procedure was in place for uncollected prescriptions and we noted weekly checks were now being carried out.

The rating awarded to the practice following our full comprehensive inspection On 14 November 2017 of ‘inadequate’ remains unchanged. The practice will be re-inspected in relation to their rating in the future.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as inadequate overall.

(Previous inspections, April 2015 – Requires Improvement, November 2016 – Good)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – requires improvement

Are services caring? – requires improvement

Are services responsive? – requires improvement

Are services well-led? – inadequate

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 –Inadequate

People with long-term conditions –Inadequate

Families, children and young people –Inadequate

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

People whose circumstances may make them vulnerable –Inadequate

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

We carried out an announced inspection at Medlock Vale Medical Practice on 14 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice did not have clear systems to mitigate risk in relation to the safe care and treatment of patients. When incidents did happen although some were investigated and discussed with lessons learnt and shared, we found not all incidents were documented and formally reviewed.
• The practice reviewed the effectiveness of the care it provided. However we found the care and treatment was not always delivered according to evidence based guidelines and action was not taken where appropriate in line with patient safety alerts in a timely manner.
• The practice systems for appropriate and safe handling of medicines were inadequate.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found appointments overall were available; however they reported challenges accessing appointments as it was not easy to access the practice by telephone.
• In general 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. A new reception manager had been appointed to ensure managers were available and visible to patients should they require assistance.
• Patients said they could make an appointment with a named GP but some said they may have to wait several days for this appointment. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a new leadership structure and staff felt supported by management. The practice 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 did not have clear systems to assess, monitor and improve the quality and safety of care provided. The practice leadership was reactive rather than proactive and did not have a proven safe track record.
• The practice had an established, proactive patient participation group.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients
• 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:

• Improve the appointments system in particular telephone access for the patient population for both on the day and pre-bookable appointments, and investigate ways to increase appointment availability.

• Improve ways to increase the number of carers that the practice has registered to ensure that they receive appropriate support.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

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 Medlock Vale Medical Practice on 22 November 2016. Overall the practice is now rated as good.

The practice had been previously inspected on 9 April 2015. Following that inspection the practice was rated overall requires improvement with the following domain ratings:

Safe – Requires improvement

Effective – Requires improvement

Caring – Requires improvement

Responsive – Requires improvement

Well-led – Requires improvement

The following requirement notices were issued as the practice was not meeting the legislation in place at that time for the following:

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment
• Regulation 18 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Staffing.

Following this re-inspection on 22 November 2016 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.

• 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.
• In general 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 can make an appointment with a named GP but some said they have to wait several days for this appointment. Urgent appointments were available the same day. Some patients commented that it was difficult to get through on the phone during peak times.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a 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 areas where the provider should make improvement are:

• Consider appraisals for nursing staff to be undertaken by a clinician.
• Continue to monitor the appointments system in particular telephone access for the patient population for both on the day and preebookable appointments, and investigate ways to increase appointment availability.
• Review the rationale for holding controlled drugs in the practice and consider their removal and appropriate destruction in accordance with medicines management principles.
• Develop ways to increase the number of carers that the practice has registered to ensure that they receive appropriate support.
• Consider other key members of staff holding a copy of the practice business continuity plan at home.

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 Medlock Vale Medical Practice on 9 April 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe, effective, caring responsive and well led services, and also for all population groups.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Risks to patients were assessed and managed, with the exception of those relating to recruitment checks.

• Data showed patient outcomes were average for the locality. Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.

• 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.

• Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments.

• The practice had a number of policies and procedures to govern activity, but some of these were a number of years old and had not been reviewed since initial publication. Some did not have issue or review dates.

• The practice did not hold regular governance meetings but issues were discussed at ad hoc meetings.

• The practice had not proactively sought feedback from staff or patients.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all required employment checks for all staff are in place.

• Ensure that all equipment is regularly calibrated and electrical equipment regularly tested for electrical safety.

• Ensure that staff receive regular supervision and appraisals to support their personal development.

• Ensure the lead for safeguarding vulnerable children is trained to level 3 and implement mental capacity act training for all staff.

In addition the provider should:

• Ensure there are formal governance arrangements in place and staff are aware how these operate.

• Ensure all staff have access to appropriate policies, procedures and guidance that are regularly reviewed and updated, to carry out their role.

• Ensure there are mechanisms in place to seek feedback from staff and patients and this feedback is responded to.

• Improve the availability of non-urgent appointments.

• Ensure audits of practice are undertaken, including completed clinical audit cycles.

• Ensure that there is a legionella risk assessment in place.
• Review the confidentiality arrangements in the reception area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We last inspected Medlock Vale Medical Practice on the 6th January 2014 and made compliance actions because we had concerns that the provider’s systems were ineffective to reduce the risk of the spread of infection. We were also concerned that the provider did not operate effective recruitment procedures that ensured staff were suitable to undertake their role.

During our inspection on the 3rd October 2014 the provider was able to provide us with evidence which demonstrated they had effective systems in place to reduce the risk of the spread of infection. We also saw recruitment processes and checks were in place ensuring staff were suitable and safe to undertake their role.

We did not speak to people who used the service during this inspection.

Generally people told us they were happy with the service they received although most people raised concerns about the appointment waiting times and the poor attitude of some of the reception staff who were described as ‘rude’ and ‘abrupt’. Similar comments were made on the NHS Choices website. One person told us, “The doctors are great. I get time to tell them about my problem and they always take time to explain things.” Another person told us, “The doctors are great, things get sorted quite quickly. Sometimes there are delays with repeat prescriptions.”

A range of leaflets and posters were displayed which meant people who used the service were provided with appropriate information about the care, treatment and support choices available.

All staff were trained in cardiopulmonary resuscitation and a record of this training was in place. The service had appropriate equipment to support people in the event of a medical emergency.

The premises were generally clean and tidy. Although the practice had an infection control lead, no formal infection control audits had taken place.

Staff were trained on child protection and safeguarding vulnerable adults and a whistle blowing policy was in place. This ensures people were safeguarded from abuse and harm and safeguarding referrals were managed correctly.

The provider did not operate effective recruitment procedures and perform appropriate checks to ensure that staff were suitable and safe to undertake their role.