Audlem Medical Practice

We carried out a comprehensive inspection of Audlem Medical Practice on 19 December 2018. We rated the practice Good overall but Requires Improvement for providing safe services because there were breaches of regulations. The breaches were:

• Regulation 12 Safe Care and Treatment, as the provider could not demonstrate the clinical reason why some medicines had been prescribed. The provider had failed to ensure that clinical records were maintained. A record of the consultation, outcome and treatment had not been recorded in patients’ clinical records. There was no system in place to audit clinical records to offer assurance that patients care and treatment was safe and appropriate.
• Regulation 13 Safeguarding, as some clinicians had not received up to date safeguarding training appropriate to their role.

We also recommended that the practice should:

• Continue to monitor the level of exception reporting at the practice and review changes made to the recall system to offer assurance that more patients are being reviewed and receiving appropriate treatment.
• The safeguarding policy and procedure should be reviewed and amended to include information and guidance with regard to female genital mutilation (FGM), modern slavery and child sexual exploitation.
• Regular reviews of the new system being put in place to offer a structured and formal monitoring and supervision system for the advanced nurse practitioners (ANPs) and salaried GPs should take place to offer assurance that the treatment being provided is safe and appropriate.
• The system in place to monitor and check that patient group directives (PGDs) were appropriately authorised to enable staff to administer medicines should be reviewed to ensure all have the required authorisation.
• Suitable infection control training should be provided to the designated infection control lead.

At this desk based follow up inspection 6 February 2020, we found that the provider had satisfactorily addressed these areas and therefore the practice is now rated as good for providing safe services.

We based our judgement of the quality of care at this service on a combination of:

• information from our ongoing monitoring of data about services and

• information from the provider, patients, the public and other organisations.

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

We carried out an announced comprehensive inspection at The Audlem Medical Practice on 19 December 2018 as part of our inspection programme.

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 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 practice as requires improvement for providing safe services because:

• The practice had systems to manage risk so that safety incidents were less likely to happen. However, we identified examples of repeated incidents/ significant events that impacted on patient safety.
• The majority of clinical staff did not have safeguarding training appropriate to their role and responsibilities.
• The practice could not demonstrate the clinical reason why some medicines had been prescribed.

We found that:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• The most recent results from the GP national patient survey (August 2018) showed patient satisfaction with the service for making an appointment, appointment times, overall experience and getting through to the practice by telephone were higher than local and national averages.
• The practice organised and delivered services to meet the needs of patients.
• There was a system in place for investigating and responding to patient feedback including complaints.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Ensure that clinical staff have received safeguarding training at a suitable level to their role.

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

The areas where the provider should make improvements are:

• Continue to monitor the level of exception reporting at the practice and review changes made to the recall system to offer assurance that more patients are being reviewed and receiving appropriate treatment.
• The safeguarding policy and procedure should be reviewed and amended to include information and guidance with regard to female genital mutilation (FGM), modern slavery and child sexual exploitation.
• Regular reviews of the new system being put in place to offer a structured and formal monitoring and supervision system for the advanced nurse practitioners (ANPs) and salaried GPs should take place to offer assurance that the treatment being provided is safe and appropriate.
• The system in place to monitor and check that patient group directives (PGDs) were appropriately authorised to enable staff to administer medicines should be reviewed to ensure all have the required authorisation.
• Suitable infection control training should be provided to the designated infection control lead.