- GP practice
Bloomfield Medical Centre
All Inspections
3 October 2018
During an inspection looking at part of the service
This practice is rated as Good overall. (Previous rating 15/03/2018 – Good with Requires Improvement in Safe)
The key question of safe is now rated as Good.
We carried out a comprehensive inspection of Bloomfield Medical Centre on 15 March 2018. The overall rating for the practice was good with the key question of safe rated as requires improvement. The practice were unable to evidence up to date systems for the risk assessment of fire safety and associated training. A requirement notice under Regulation 12 was issued. The full comprehensive report on the 15 March 2018 inspection can be found by selecting the ‘all reports’ link for Bloomfield Medical Centre on our website at www.bloomfieldmedical.co.uk.
This desk top review was carried out on 03 October 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach identified in the requirement notice.
Our key findings were as follows:
The practice had done all that was reasonably practicable to mitigate risks to the health and safety of service users receiving care and treatment.
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.
15 March 2018
During a routine inspection
This practice is rated as Good overall. (Previous inspection March 2016 the practice was rated good overall – Good)
The key questions are rated as:
Are services safe? – Require Improvement
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
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) – Good
We carried out an announced comprehensive at Bloomfield Medical Centre on 15 March 2018. This inspection was carried out 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 was 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 leadership at the practice had a clear vision, which put working with patients to ensure high quality care and treatment as its top priority. There was a commitment by all the practice staff to deliver a quality service.
- There was a good understanding of the local population health and social care needs and recognition of the specific challenges this provided to the practice in delivering high quality care and treatment.
- 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. A range of policies and procedures were available however we noted some required updating and some clinical protocol for practice nurse activities required development
- The practice held weekly informal clinical meetings where patient and practice issues were discussed however minutes of these meetings were not recorded. The clinical pharmacist and practice nurses held regular clinical meeting where issues and learning and development was shared.
- The systems in place to report, investigate and respond to significant events and complaints were comprehensive and there was good evidence the provider complied with the Duty of Candour.
- The practice implemented comprehensive systems to ensure patients were safeguarded from abuse. Staff were trained and there were systems to monitor patients identified at risk of abuse.
- The practice ensured that safe systems were in place for patients referred on the two week pathway and those prescribed high risk medicines. There were care plans in place for vulnerable patients and for those assessed as frail.
- The practice had systems in place to respond to medical emergencies.
- Staff were recruited appropriately. Systems to appraise and develop staff skills and abilities were implemented and feedback from those staff we spoke to felt this was positive and supportive.
- The practice fire risk assessment was not up to date and some fire safety procedures needed improving.
- Governance arrangements to monitor and review the service were implemented and the practice worked closely with the clinical commissioning group to ensure safe and effective service delivery.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
The area where the provider must make improvements as they are in breach of regulations are:
- Ensure care and treatment is provided in a safe way to patients.
The areas where the provider should make improvements are:
- Maintain minutes of the weekly clinical meetings to provide a record of attendance and an audit trail of items discussed and decisions agreed.
- Review the availability of nurse clinical protocols to support the practice nursing team.
- Update policies and procedures to reflect current legislation and guidance including the recruitment procedure and the complaints procedure.
- Continue to promote the patient participation group for the practice.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
30/08/2016
During a routine inspection
Letter from the Chief Inspector of General Practice
This is a focused desk top review of evidence supplied by Dr AM Doyle’s Practice for four areas within the key question safe.
We found the practice to be good in providing safe services. Overall, the practice is rated as good.
The practice was inspected on 16 March 2016. The inspection was a comprehensive inspection under the Health and Social Care Act 2008 (HSCA). At that inspection, the practice was rated ‘good’ overall. However, within the key question safe, four areas were identified as requires improvement, as the practice was not meeting the legislation at that time; Regulation 12 Safe care and treatment HSCA (Regulated Activities) Regulations 2014.
At the inspection in March 2016 we found that:
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The practice had up to date fire risk assessments but regular fire evacuation drills had not been carried out.
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Clinical equipment was checked to ensure it was working properly. However, other non-clinical electrical equipment had either not been safety checked or had not been checked since 2013.
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All clinical staff received annual basic life support training. However, basic life support training or appropriate risk assessments had not been completed for non-clinical staff since March 2014.
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The practice had a secure system to record and keep prescription pads safe but had no system in place to track and monitor the use of loose blank prescription forms.
The practice supplied an action plan and a range of documents which demonstrated they are now meeting the requirements of Regulation 12, Safe care and treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
16/03/2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr AM Doyle’s Practice on 16 March 2016. 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 report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
- The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice, together with a neighbouring practice, employed a nurse practitioner to work with vulnerable elderly patients both in care homes and in their own homes.
- Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example, the practice worked together with a neighbouring practice to provide a multi-disciplinary team that managed patients with long-term conditions in the community.
- The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, the practice installed a bicycle rack for patient use and made improvements to the patient waiting area.
- Clinicians carried out regular peer review of the quality of medical records based on a recognised Royal College of GPs (RCGP) template. These reviews were discussed in clinical meetings and any opportunities for quality improvement identified and put in place.
- 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.
- There was a clear leadership structure and staff felt supported by management.
- The provider was aware of and complied with the requirements of the Duty of Candour.
We saw several areas of outstanding practice including:
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Three of the practice clinical staff were diabetic specialist nurses who were able to initiate insulin in the practice. In the preceding 12 months, we saw evidence that HbA1c levels for diabetic patients were improved (HbA1c levels indicate average blood sugar levels in diabetic patients).
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The practice was part of a scheme to identify and manage patients who were complex, frequent callers to services. They worked with those patients to reduce the number of contacts that were made by offering face-to-face support and making referrals to the appropriate services.
- The practice worked in conjunction with other services to support patients who were difficult to engage. By establishing relationships with those patients and putting processes in place this resulted in better outcomes for those patients.
- One of the practice pharmacists was the NHS 111 service clinical lead for the North West and worked on developing protocols and formularies for the prescribing of medications. These were shared with other services in the Clinical Commissioning Group (CCG).
However, there were areas of practice where the provider must make improvements:
- Ensure that all staff receive training in basic life support training in a timely manner in line with the latest guidance or have an appropriate risk assessment in place.
- Ensure that regular fire drills are undertaken and staff are adequately trained and updated in fire safety.
- Ensure that it is satisfied that all electrical items are maintained and safe to use.
- Maintain a safe recording system to monitor and track loose prescription forms.
The areas of practice where the provider should make improvements are:
- Conduct a legionella risk assessment for the building (legionella is a term for a particular bacterium which can contaminate water systems in buildings).
- Maintain the procedure to ensure that Patient Specific Directions are produced to provide written evidence of authorisation by a qualified prescribing clinician when vaccinations are given by a Health Care Assistant.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice