Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection November 2014 – Good)

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

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

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

People whose circumstances may make them vulnerable – Good

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

We carried out an announced comprehensive inspection at Roe Lee Surgery on 8 November 2017 as part of our inspection programme to inspect 10% of practices before April 2018 that were rated Good in our previous inspection programme

At this inspection we found:

• The practice ensured that care and treatment was delivered according to evidence- based guidelines and reviewed the effectiveness and appropriateness of the care it provided.

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice documented investigations resulting from them and improved their processes. However, documentation did not always clearly identify learning outcomes. While staff demonstrated awareness of recent incidents, we found communication channels to disseminate learning was at times informal.

• 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.

• Staff felt respected, valued and supported.

• The practice engaged positively with integrated working alongside other professionals. Regular multidisciplinary team meetings took place to ensure person-centred care was delivered to patients.

• Quality improvement issues were discussed in regular staff meetings. Clinical matters were discussed in weekly meetings although there were no formal minutes kept for these meetings.

• There was a strong focus on continuous learning and improvement at all levels of the organisation. The partners and management team were keen to contribute and add value to the local healthcare economy.

We saw two areas of outstanding practice:

• The practice had developed a care pathway for the management of deep vein thrombosis (DVT; a blood clot that develops within a deep vein in the body, usually in the leg) and delivered this service for all patients across the clinical commissioning group area. This had streamlined access to services for patients as well as resulting in considerable cost savings over a two year period.

• The practice worked in partnership with a local hospital trust in offering patients access to non-obstetric ultrasound services in the primary care setting, facilitating faster access to diagnostic scans for patients. The practice told us the implementation of this service had reduced waiting times for patients from eight weeks down to two weeks or less.

The areas where the provider should make improvements are:

• Consider the improving the recording of incident investigations and formalise communication channels to ensure learning is disseminated effectively.

• Consider the detail of policy and procedure documents, such as that for needlestick injury.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected Roe Lee Surgery on 11 November 2014 as part of our new comprehensive  inspection programme. We looked at how well the practice provided services for all population groups of patients. The inspection took place at the same time as other inspections of GP practices across Blackburn with Darwen Clinical Commissioning Group.

The overall rating for this practice is Good.

Our key findings were as follows:

• Well established systems were in place to ensure information about safety was recorded, monitored, reviewed and actioned.
• Lessons were learned and communicated widely to support improvement. 
• Feedback from patients about their care and treatment was consistently positive.
• We found the practice supported a strong team based ethos and this was reflected across all staff.
• Patients with substance misuse problems had access to a weekly drug and alcohol support and treatment clinic.
• The practice provided care and treatment for women who reside in a women’s refuge

However there was also an area of practice where the provider needs to make improvements. 

The provider should:

• Ensure that enhanced Disclosure and Barring checks are undertaken for clinical staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as requires improvement overall. (Previous rating November 2017 – Good)

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 Roe Lee surgery on 7 November 2018 in response to concerns raised with us.

At this inspection we found:

• The practice had negotiated a challenging period of transition since merging with another local practice and incorporating a branch site a year ago. There had been a high turnover of staff at the branch site, although staff told us how the situation had improved over recent months.
• There were gaps in the practice’s governance arrangements resulting in risk management processes not being comprehensive, for example in respect to recruitment procedures and training oversight.
• While the practice had a range of documented policies and procedures in place, we found examples where these either had not been followed, or lacked sufficient detail to adequately describe the processes to which they related.
• The practice had some systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice documented investigations resulting from them and improved their processes. However, some staff found it difficult to demonstrate awareness of recent incidents and we found communication channels to disseminate learning was at times informal.
• The practice ensured that care and treatment was delivered according to evidence- based guidelines and reviewed the effectiveness and appropriateness of the care it provided.
• Staff involved and treated patients with compassion, kindness, dignity and respect. Patients felt positive about the quality of care and treatment they received. The practice’s results from the national GP patient survey were higher than local and national averages.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure specified information is available regarding each person employed.

The areas where the provider should make improvements are:

• The provider should implement a formal process of monitoring clinical decisions made by staff working in advanced roles in order to be assured staff are working within their competencies.
• Actions completed on receipt of patient safety alerts should be logged in order to provide a clear audit trail of what has been done.
• Complaints literature should be easily accessible for patients
• Processes around auditing infection prevention and control measures should be improved. Audits should incorporate both practice sites.
• Communication channels should be formalised to ensure learning from significant events and complaints is maximised and shared efficiently with the wider practice team.

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