Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mosslands Medical Practice on 10th September 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, 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 practice carried out a robust audit and review programme with completed clinical audits and planned audits which included independent nursing audits and joint review with nurses. They acted on information obtained from the audits to improve services for patients.

We saw areas of outstanding practice:

• The nursing team had a particularly good shared peer support and cross revalidation system between themselves and other practices. This was to ensure that best practice was always adhered to for the benefit of the patients.
• There was a strong affiliation with community services, children’s services, district nursing teams, pharmacy and other support groups which were located in the building and nearby. This created particularly good communication opportunities and increased timely responses for patients using combined services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The practice leaflet gave the contact telephone number, opening times and advice to patients about out of hour’s arrangements. There was also information about how to make a complaint including contact details for the local patient advice and liaison (PALs) team.

Patients we spoke with told us: “I have no complaints, I mostly see the same GP.” “It is great.” “I can always get an appointment and don’t wait long.” “I am always told if there is a delay.” “I am quite happy with the care I receive.”

We saw that staff had attended training in relation to child protection and safeguarding adults. The registered manager (one of the GP's) had achieved level three safeguarding and was the safeguarding lead within the practice. All other staff had completed level one, two or three safeguarding training.

We saw staff meetings were held and minutes were kept. We looked at the minutes of the most recent meeting that covered topics such as; new patient registrations, handover and patient requests.

This practice is rated as requires improvement overall. (Previous rating September 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

We carried out an announced comprehensive inspection at The Mosslands Medical Practice on 13 November 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice had systems that needed improving to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes, but learning was not always shared across the practice.
• 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.
• Some patients told us they found it difficult getting through to someone on the phone and this was corroborated by the national GP patient survey results.
• There were no processes in place to provide all staff with the development they needed and training was out of date for some staff members.
• Some practice policies were not regularly reviewed and the service did not have policies in place for processes such as acting on patient safety alerts.
• Identified risks had not always been acted on, for example there were actions still to be completed from the fire risk assessment.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• The practice should keep a log of all blank prescriptions.
• The practice should consider having whole practice meetings.
• The practice should have a cleaning schedule in place for clinical rooms.
• Incidents that are documented should reference which patients are affected.
• The practice should review their scores for patients getting through to someone on the telephone.

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

Please refer to the detailed report and the evidence tables for further information.