The Care Quality Commission
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Archived: Clayton Brook Surgery

Overall: Good read more about inspection ratings

Tunley Holme, Clayton Brook, Bamber Bridge, Preston, Lancashire, PR5 8ES (01772) 313950

Provided and run by:
Clayton Brook Surgery

All Inspections

17 January 2018

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Clayton Brook Surgery on 30 May 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the May 2017 inspection can be found by selecting the ‘all reports’ link for Clayton Brook Surgery on our website at www.cqc.org.uk.

Following our inspection in May 2017 we rated the practice as requires improvement for providing effective, caring and well-led services and as requires improvement overall. We issued a requirement notice in relation to good governance.

This inspection was an announced focused inspection carried out on 17 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified in our previous inspection on 30 May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

  • The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes. There were comprehensive records kept to evidence shared learning.

  • The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured care and treatment was delivered according to evidence- based guidelines.

  • Staff involved and treated people with compassion, kindness, dignity and respect.

  • There was a strong focus on continuous learning and improvement at all levels of the organisation.
  • There were good systems in place for the safe storage of refrigerated vaccines. Following our last inspection, staff had been trained in monitoring fridge temperatures and there was a documented process attached to the practice fridges.
  • The practice had changed its recruitment procedure to ensure GP locum staff were of good character and were suitably trained. There was evidence of this in the new locum GP file that we viewed.
  • We saw a new infection prevention and control audit had taken place and that the practice had produced an action plan. They had addressed this plan in all areas save for those relating to premises refurbishment which were in the process of being reviewed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

30 May 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Clayton Brook practice on 5 October 2016. The practice was rated as inadequate for providing safe, effective, caring and well-led services, requiring improvement for responsive services and inadequate overall. The practice was placed in special measures for a period of six months.

At our inspection in October 2016, we found that the practice did not ensure that persons providing care and treatment to service users had the qualifications, competence, skills and experience to do so. Staff training was inadequate and staff were acting outside their levels of competency. There were insufficient staff to provide a good level of service to patients. We found that patients were at risk of harm because systems and processes were not in place to keep them safe and there was no systematic approach to assessing and managing risks. Practice policies and procedures were not well managed. There was no comprehensive programme of quality improvement and the procedure for reviewing and acting on significant incidents was inadequate. The practice registration with the CQC was incorrect since December 2013.

The full comprehensive report on the October 2016 inspection can be found at: http://www.cqc.org.uk/location/1-544061997

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 30 May 2017. Overall the practice is now rated as requires improvement.

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

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, minutes of meetings sometimes lacked details of discussion of significant events and actions taken as a result of incidents were not always reviewed to be effective.
  • We saw evidence of clinical audit activity although there was a lack of evidence to show that practice systems had been changed as a result of these audits and learning shared.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • The arrangements for managing medicines in the practice generally kept patients safe; however, there was evidence of lack of staff training in the practice cold chain procedure and the protocol for the repeat prescribing of medicines needed review.
  • The practice had undertaken appropriate recruitment checks for new members of practice staff although locum GP files lacked character references and evidence of suitable training.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment although the practice nurse lacked training for the role as infection prevention and control lead.
  • We were told that clinical staff met regularly for peer review and to discuss clinical issues. However, there were no records kept of these meetings to evidence this and share learning. There were no records of clinical supervision and staff told us that this was lacking.
  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns although evidence for this was sometimes lacking.
  • Patients we spoke with and comments we received said patients found it easy to make an appointment with a named GP and 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 generally felt supported by management. However, some staff we spoke to said that they felt unsupported by management and there was little evidence of clinical supervision. One staff member reported a lack of communication.
  • There was a lack of formal systems to review areas of quality improvement such as significant events, complaints, audit and patient safety alerts, and actions taken as a result of these. We were told that clinical meetings took place to discuss clinical audits and patient care and treatment but there were no minutes for these meetings to share information and evidence learning.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvement are:

  • Consider further staff training in the management of refrigerated medicines and further training for the practice clinical infection prevention and control lead.
  • Obtain assurance that GP locum doctors employed by the practice are of good character and are suitably trained for the role.
  • Address the actions identified by the last infection prevention and control audit.

I am taking this service out of special measures. This recognises the improvements made to the quality of care provided by this service.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

5 October 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Clayton Brook Surgery on 5 October 2016. Overall the practice is rated as inadequate.

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

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example there had been no staff training in infection control and no recent infection prevention and control audit. There was limited activity to assess and identify risks and evidence of failure to mitigate those risks that were identified.
  • Some members of staff were working outside their professional capabilities without any training for the role. Staffing levels were not maintained at a level necessary to provide a good service to patients.
  • Staff were clear about reporting incidents, near misses and concerns but there was no evidence that actions taken as a result of those incidents were reviewed in a timely way.
  • The practice was aware of but did not have systems in place to ensure compliance with the requirements of the duty of candour.
  • There was a general lack of staff training and no training programme for staff.
  • There was little evidence of practice commitment to long-term learning and improvement. There was minor commitment to audit and there was little evidence that the practice was comparing its performance to others; either locally or nationally.
  • Patients were generally positive about their interactions with staff and said they were treated with compassion and dignity. However, the national patient survey and evidence collected from patients on the day, indicated dissatisfaction with some aspects of the service.
  • We saw that complaints were dealt with in a timely manner and an appropriate apology was offered when required.
  • The practice had limited formal governance arrangements.
  • The practice was incorrectly registered with CQC. They were registered as a partnership instead of as an individual provider.
  • The practice worked well with its patient participation group.

The areas where the provider must make improvements are:

  • Put systems in place to ensure staff are appropriately trained and that training remains current for their role. Ensure that all staff are not working outside their level of professional competency including the practice nurse in the management of patient medications, patient test results and hospital communications.
  • Carry out infection prevention and control audit activity to assess compliance with infection prevention and control requirements and take action to mitigate any risks identified.
  • Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision. Carry out risk assessments to ensure the safety of staff and patients; in particular those related to health and safety at work, staff acting as chaperones, fire safety and building electrical safety. Implement the control regime identified by the legionella risk assessment.
  • Ensure that policies and procedures available to staff are updated accordingly.
  • Ensure that evidence of any necessary training and professional indemnity is sought for all clinical staff.
  • Carry out quality improvement activity for example clinical audits including re-audits to ensure improvements have been achieved.
  • Review the staffing structure and ensure there is leadership capacity to deliver all improvements.
  • Put systems in place to ensure that risks associated with medications, blank prescriptions and patient confidential information are addressed.
  • Ensure that patient safety alerts are shared with staff and that required action has been taken.

The areas where the provider should make improvement are:

  • Introduce processes to ensure that actions implemented following significant events, incidents and near misses are reviewed to be effective in a timely way.
  • Display notices to advise patients that they can request a chaperone.
  • Improve the process for identifying and recording carers.
  • Include all appropriate areas of the building in the practice cleaning schedule.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice