Broseley Medical Practice

We previously carried out an announced comprehensive inspection at Broseley Medical Practice on 11 December 2018. The overall rating for the practice was good with requires improvement for providing a safe service. The full comprehensive report on the December 2018 inspection can be found by selecting the ‘all reports’ link for Broseley Medical Practice on our website at www.cqc.org.uk.

We carried out an announced inspection on 9 December 2019 to follow up on areas for improvement identified at the previous inspection and found improvements had been made in providing a safe service in addition to the good practice recommendations made in relation to providing effective and well-led services.

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 and other organisations.

We have rated this practice as Good in providing a safe service and Good overall.

At this inspection we found:

• Recruitment procedures had been reviewed and improved to ensure only fit and proper persons were employed.
• The significant event reporting and recording system had been reviewed and changes implemented to improve the quality of patient care from lessons learnt.
• An effective system for the monitoring of high-risk medicine prescribing had been implemented.
• Staff had completed outstanding essential training including training in safe working practices.

The practice had also met the good practice recommendations made in relation to providing effective and well-led services. These improvements included:

• The quantity and quality of audits undertaken had improved to drive quality improvement.
• A documented business plan and strategy to support the practice’s aim to deliver high quality care and promote good outcomes for patients had been developed.
• Governance arrangements had been strengthened to include appointing an office supervisor and developing a working guide for reception staff. Monthly office meetings had also been implemented.
• The practice had worked with their patient participation group (PPG) in responding to the results of the national GP patient survey and undertaking their own survey regarding access to the service. A new telephone system had since been implemented and additional telephones obtained.

The following good practice recommendation remained outstanding from the previous inspection:

• Consider sharing current evidence-based guidance in clinical meetings.

The following good practice recommendation was made as a result of this inspection:

• Undertake a risk assessment to record the processes non-clinical staff follow to protect themselves and patients in the absence of immunisation for hepatitis B.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of General Practice

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

We carried out an announced comprehensive inspection at Broseley Medical Practice on 11 December 2018 as part of our inspection programme. The practice was previously inspected in October 2014 and rated as good.

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 good overall and good for all population groups.

We rated the service as requires improvement for providing safe services because:

• The practice did not have effective recruitment processes in place to keep patients safe and protected from potential harm.
• Clinicians knew how to identify and manage patients with severe infections including sepsis however, not all clinicians coded physiological data which would trigger the sepsis alert protocols within the practice clinical system.
• The process for ensuring patients received the necessary monitoring before high risk medicine was prescribed for them was not always effective when patients had shared care arrangements.
• There were few significant events recorded; this prevented effective improvement to the quality of patient care delivered from lessons learnt through events.
• Staff had access to training opportunities to support them in their work. However, some staff were not up to date with essential training in safe working practices.

We rated the practice as good for providing effective, caring, responsive and well-led services because:

• Patients received effective care and treatment that met their needs.
• The practice worked closely with outside agencies to improve the care delivered.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care. Staff felt that the benefits of working in a small team enabled them to be more patient orientated and provided opportunity to get to know their patients.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• Patients received effective care and treatment that met their needs.
• The practice’s uptake rates for childhood immunisation were above the World Health Organisation (WHO) 95% targets.
• The practice had experienced significant staff and recruitment challenges and as a result had reviewed and made changes to their workforce to meet the needs of their patient population.
• The practice was working collaboratively with other local practices to bring more flexible evening and weekend appointments to patients.
• The practice provided an in-house counsellor and had a community and care co-ordinator to help assist patients of any age in need of help, support and advice by offering a signposting service and support with social isolation.
• Regular meetings were held with staff to communicate to share information and practice performance.
• Leaders were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.
• There were clear responsibilities, roles and systems of accountability to support good governance and management and most staff felt supported by the management. However, there were areas where these needed to be strengthened.

The areas where the provider must make improvements are:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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

The areas where the provider should make improvements are:

• Review the significant events reporting and recording system to improve the quality of patient care from lessons learnt.
• Develop an effective system for the monitoring of high risk drug prescribing.
• Review how all staff complete outstanding essential training.
• Consider sharing current evidence based guidance in clinical meetings.
• Review and improve the quality of audits undertaken to drive quality improvement.
• Formulate an action plan for responding to the results of the national GP patient survey to include actions to address the lower than average results regarding access to the service
• Develop a documented business plan and strategy to support the practice’s aim to deliver high quality care and promote good outcomes for patients.
• Continue to strengthen governance arrangements.

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