This practice is rated as Good overall.

At our previous inspection on 11 July 2016 the practice was rated as good overall, with requires improvement for providing safe services and good for providing effective, caring, responsive and well-led services.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

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) - Outstanding

We carried out an announced comprehensive inspection at Skerne Medical Group on 15 February 2018

. This was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 11 July 2016. W

e inspected this service as part of our comprehensive inspection programme.

At this inspection we found:

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses.

• Outcomes for patients who use services were good.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• The skill mix of the clinical team had been enhanced, with the addition of advanced nurse practitioners with different clinical interests. This allowed for better access for patients and freed up GP time to focus on more complex issues.

• Staff were consistent and proactive in supporting patients to live healthier lives through a targeted approach to health promotion. Information was provided to patients to help them understand the care and treatment available.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

• The practice was the second lowest dermatology referrers in the locality. They had in house expertise of dermatology from the GPs. They had the facility to use a dermatology service where photographs of skin lesions were sent to the dermatologist for opinion which saved on hospital referrals.

• Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.

• There was a leadership structure in place and staff felt supported by management. The practice sought feedback from staff and patients, which they acted on.

• The practice was aware of and complied with the requirements of the duty of candour.

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

We saw two areas of outstanding practice:

• The practice had a primary care mental health specialist on site for patients between the ages of 18 and 65 who presented with common mental health problems. The practice could refer patients directly to the service and they were generally seen within 48 to 72 hours. The practice currently had 44 open cases, since June 2017, which had been referred. Waiting times for patients to be referred to secondary care for this type of service were three months.
• Following a review of ENT referrals at the practice a support group was set up to provide counselling for patients who had tinnitus. This was for 12 patients on a six week programme. This covered the cause of tinnitus, what makes symptoms worse, equipment that may help, coping with stress and information on alternative therapies. Following the success and positive patient feedback from this group a second group was organised for March 2018. This ran with maximum numbers of patients. Data from August – October 2016 when compared to the same period in 2017 shows that referrals for tinnitus to secondary care reduced from thirteen to four.

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 Skerne Medical Group on 11 July 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an system in place for reporting and recording significant events.
• Risks to patients were mainly assessed and managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been mainly trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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 found it easy to make an appointment with a GP, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure necessary checks required to show safe recruitment and selection procedures. Not all staff who acted as a chaperone had received a Disclosure and Barring Services (DBS) check.

• Ensure the proper and safe management of vaccinations.Vaccinations should be stored securely and staff responsible for the management of vaccinations should be suitably trained.

The areas where the provider should make improvement are:

• The practice’s record of training should demonstrate accurately training that has been delivered.

• Ensure all staff receive appropriate appraisal

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice