We carried out an announced comprehensive inspection at Parbold Surgery on 22 January 2019. We had previously inspected the practice in May 2018; this inspection had resulted in an overall rating of requires improvement. We issued the practice with a requirement notice for a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance). The full comprehensive report following the inspection in May 2018 can be found on our website here: https://www.cqc.org.uk/location/1-583471641.

We carried out our most recent inspection in order to ensure the practice had implemented appropriate improvements.

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:

• Although systems to manage and identify learning following incidents and near misses had improved, oversight was insufficient to ensure they were operating effectively. Incidents and associated learning were not logged in a timely manner and documentation was not always comprehensive enough to provide a clear description of what had happened.
• Risks were not always comprehensively mitigated, in particular in relation to recruitment processes.
• Actions following receipt of safety alerts were not always appropriate to fully mitigate risks to patients.

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

• We identified further gaps in the practice’s governance arrangements, despite improvements being implemented to address specific concerns identified at our May 2018 inspection.
• Oversight of practice policies was lacking, for example the significant event policy was not being followed in practice, and the safeguarding policies contained outdated information.

However, we also found that:

• The practice had appropriately addressed concerns raised at our May 2018 inspection relating to the management of incoming correspondence and uncollected prescriptions.
• Patient feedback was strongly and consistently positive anout the standard of care and treatment received.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• 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.

(Please see the specific details on action required at the end of this report).

In addition, the provider should:

• Improve the identification of carers to enable this group of patients to access the care and support they need.
• An action plan should be generated following completion of the infection prevention and control (IPC) audit and health and safety risk assessments to ensure appropriate oversight of any required improvements.

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