Archived: The Boulevard Medical Practice

We carried out an announced focused inspection at The Boulevard Medical Practice on 21 August 2019. The practice was previously inspected by the Care Quality Commission on 2 December 2015, when it received a rating of Good overall, with a rating of outstanding for being Well Led.

We carried out an inspection of this service due to the length of time since the last inspection. Following our review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions: Are services effective? Are services well-led?

We based our judgement on 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
• Information from the provider, patients, the public and other organisations

We have rated this practice as good overall.

We concluded that:

• Staff had access to relevant, up to date evidence-based guidance in order to best meet patients’ needs.
• A range of quality improvement activity was carried out by clinical and non-clinical staff, and actions and learning was widely shared and implemented.
• Patients with long-standing mental health problems, including those with depression, were reviewed on a three to six monthly basis, to closely monitor their progress.
• Staff were supported to learn through use of innovative and interactive teaching and training systems.
• A whole team approach was in place to support continual improvement, through the use of a ‘good ideas’ scheme which generated prizes and awards.
• Staff told us they felt supported and valued by the leadership team at the practice.
• The practice worked collaboratively with local partners and became involved in local initiatives to meet the changing needs of their patient population.

However, we also found that:

• Systems to record and update details of staff training completed were not sufficiently clear.
• Policies and protocols were updated on an ‘ad hoc’ basis. We were informed that plans were in place to formalise arrangements for regular, routine updating. We viewed a sample of protocols, policies and ‘how to’ guides, and saw these were appropriate and had been updated in a timely way.
• The premises had experienced a long-standing roof leak which was affecting two non-clinical rooms. Efforts were being made to encourage the landlord to repair the damage caused.

The areas where the provider should make improvements are:

• Improve the systems for maintaining a clear and accurate picture of training completed by staff at all levels.
• Implement a formal process whereby practice policies and protocols are reviewed and updated in a structured manner.
• Continue to liaise with the landlord to repair damage caused to parts of the practice premises by leakage from the roof.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care