This practice is rated as requires improvement overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Netherton Practice on 11 December 2018 as part of our inspection programme.

At this inspection we found:

• The practice had systems to manage risk and to ensure that safety incidents were less likely to happen. However, the learning from incidents was not well communicated across the staff team.
• The systems in place for safeguarding patients from the risk of abuse were not robust. This was because there was no designated lead for safeguarding in the practice and a safeguarding register had only recently been produced.
• All clinical sessions were delivered by locum GPs and an agency practice nurse. The provider had taken steps to ensure as much consistency as possible in the use of temporary staff and systems were in place to support the clinical team such as regular meetings. However, members of the clinical team were not always taking these up.
• There were systems in place to reduce risks to patient safety. A risk register was in place and this was monitored.
• There were shortages in the staff team and the practice had been taking on a high number of new patients. This was not being managed effectively and if not addressed could lead to the practice being unable to meet patients care and treatment needs in a timely and safe manner.
• Medicines were not always being managed in line with policies and procedures.
• Procedures to prevent the spread of infection were in place and regular Infection control and cleanliness audits were carried out.
• Systems were in place to deal with medical emergencies and staff were trained in basic life support.
• Clinicians assessed patients’ needs and delivered care in line with current evidence based guidance in those areas we explored.
• Data showed that outcomes for patients at this practice were comparable to outcomes for patients locally and nationally.
• Systems to review the effectiveness and appropriateness of the care provided were in place and some of these were being developed further. However, there were no clinical audits being carried out at the practice.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Staff told us they felt supported in their roles.
• Patients told us they were treated with dignity and respect and involved in decisions about their care and treatment. Some patients felt there was little consistency in the clinical team. The provider had taken action to reduce the number of clinical staff used.
• Systems were in place to check on the quality of the service. However, these were not fully effective for this location as we identified shortfalls.

The areas where the provider must make improvements are:

• Ensure the systems in place for safeguarding patients include a designated safeguarding lead and ensure that safeguarding registers are reviewed on a regular basis.
• Review the governance systems to ensure these are fully effective in monitoring the service, managing risks and driving improvement.

The areas where the provider should make improvements are:

• Review staffing levels and staff capacity to ensure this is sufficient to meet demand.
• Ensure procedures relating to the management of medicines and prescribing are followed appropriately.
• Ensure that clinical audits are carried out as part of their assessment of clinical effectiveness and to improve outcomes for patients.
• Identify carers in order to ensure these patients are offered appropriate advice and support
• Improve system for communication with the staff team.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice