Letter from the Chief Inspector of General Practice

We undertook an inspection of Dr R S Pollock’s Practice on 18 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 practice was rated as good overall.

Our key findings were as follows:

• Care was provided in an environment which was clean and well organised

• Feedback from patients about their care and treatment was consistently positive.

• We found the practice had a strong team based ethos and this was reflected across all staff.

• Systems were in place to ensure information about safety was recorded, monitored, reviewed and actioned.

• The Patient Participation Group (PPG) was effective in promoting changes and the Chair was proactive in engaging with the locality practices and Clinical Commissioning Group.

We saw several areas of outstanding practice including:

• Work with the self-care coordinator was improving care, treatment and outcomes for patients with long term conditions

• The practice worked closely with the district nurses and other community services in the implementation of a virtual ward providing care and treatment in patients’ homes. This provided intensive support for patients with complex care needs or who were particularly frail and elderly and avoided unnecessary hospital admission.

• A direct telephone line was available for appointments for all patients with long term conditions and a care plan.

• We were made aware that the GPs gave their own telephone number out of hours to patients and visited those who were terminally ill or approaching end of life , even though they were not on call and services were delegated to the out of hours provider.

• Staff were aware on a daily basis if any patient’s condition had deteriorated by means of a TLC board. Kept in the administration office, this was used to raise awareness amongst staff of any concerns about patients.

However, there were also areas of practice where the provider needs to make improvements.

In addition the provider should:

• Ensure there is formal policy guidance for staff in respect of medicines management and significant event management.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

This practice is rated as requires improvement overall. (Previous rating February 2015 – 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 St Georges Surgery on 25 October 2018 as part of our inspection programme.

At this inspection we found:

• 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 had not been followed.
• The practice had systems to identify and investigate safety incidents so that they were less likely to happen again. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Feedback from patients was consistently and strongly positive about the quality of care and treatment offered by the practice.
• The practice had a well-managed appointment system which facilitated timely access for patients.
• Staff told us of a strong team ethos at the practice and that they felt supported by the partners and management.

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:

• Maintain a log of patient safety alerts which contains sufficient detail so as to be assured that any necessary actions have been completed.
• Communication channels should be formalised to ensure learning from significant events and complaints is maximised and shared efficiently with the wider practice team.
• Risks associated with the storage of blank printer prescription paper should be assessed and mitigating actions taken as necessary.

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