Background to this inspection
Updated
9 March 2018
Manchester Road Surgery, 187-189 Manchester Road, Burnley, BB11 4HP is part of the NHS East Lancashire Clinical Commissioning Group (CCG) and has approximately 4735 patients. The practice provides services under a General Medical Services contract, with NHS England.
Information published by Public Health England rates the level of deprivation within the practice population group as level two on a scale of one to 10. Level one represents the highest levels of deprivation and level 10 the lowest.
The numbers of patients in the different age groups on the GP practice register are generally similar to the average GP practice in England. The practice has 61% of its population with a long-standing health condition, which is higher that the local average of 56% and the England average of 53%. In addition, 14% of the practice population are unemployed compared to the CCG average of 5% and the England average of 4%.
The GP practice provides services to patients from a double fronted Victorian property that was originally two separate buildings. There is ramped access available both at the front and rear of the building, although automated opening of doors is not available upon entering the surgery. The practice has two GP consulting rooms and four treatment rooms, which are used by the practice nurse, the two health care assistants and the midwife who attends weekly.
The surgery is open Monday to Friday between 8am and 6.30pm with extensions on Tuesday evenings (open until 7.45pm) and Thursday mornings (open from 6.45am) for pre-bookable appointments. The practice provides a range of on the day, urgent and pre-bookable routine appointments and there is provision for children to be seen the same day. The practice provides online patient access that allows patients to book appointments and order prescriptions.
The service is led by two GP partners (one male, one female). They are supported by a practice manager, a full time practice nurse who is also a non medical prescriber, two part time health care assistants as well as an administration team including a deputy practice manager, secretary and reception staff.
The practice is a teaching practice for year four and year two medical students.
When the practice is closed patients are asked to contact NHS 111 for Out of Hours GP care.
Updated
9 March 2018
Letter from the Chief Inspector of General Practice
This practice is rated as Requires Improvement overall. (Previous inspection May 2017 – Inadequate)
The key questions are rated as:
Are services safe? – Requires Improvement
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Requires Improvement
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 – Requires Improvement
People with long-term conditions – Requires Improvement
Families, children and young people – Requires Improvement
Working age people (including those recently retired and students – Requires Improvement
People whose circumstances may make them vulnerable – Requires Improvement
People experiencing poor mental health (including people with dementia) - Requires Improvement
We undertook a comprehensive inspection of Manchester Road Surgery on 10 May 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as inadequate and we issued warning notices for breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe care and treatment) and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance). The practice was placed into special measures following this visit.
We undertook a follow up focused inspection of Manchester Road Surgery on 10 October 2017. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice had addressed concerns identified in the warning notices we issued. This inspection in October 2017 found the practice had complied with the regulation 12 and 17 warning notices. Both the full comprehensive and focussed follow up inspection reports relating to these previous inspections can be found on our website here: http://www.cqc.org.uk/location/1-550124196/reports.
A further announced comprehensive inspection of Manchester Road Surgery was undertaken on 10 January 2018. This inspection was carried out following the period of special measures to ensure further improvements had been made.
Overall the practice is now rated as requires improvement.
Our key findings were as follows:
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Improvements had been made to systems to monitor patients prescribed specific high risk medications.
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The practice was actively undertaking patients’ medicines reviews to ensure appropriate care was being offered. However, we did find one example where the monitoring of high risk medicines had not been effective.
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There was improved coding of vulnerable patients on the practice’s electronic record system which facilitated more thorough managerial oversight of this at risk group.
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Patients told us they felt positive about the care and treatment they were given.
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Audits had been undertaken which showed some evidence of quality improvement.
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We found complaints were handled well, with an appropriate apology offered and an explanation of any actions put in place as a result.
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While we saw the practice investigated incidents and identified learning outcomes as a result, the dissemination of this learning and any changes to practice was inconsistent.
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Some improvements had been made around risk management, but we found some examples where recommended mitigating actions had not been completed.
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Some policies and procedures lacked sufficient detail to adequately govern the activity to which they related.
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Documentary evidence of mandatory training completed by the GPs was not thorough.
- Recruitment checks for permanently employed staff members was found to be thorough, however there were gaps in documentation of pre-employment checks for a locum GP.
There were areas of practice where the provider needs to make improvements.
Importantly, the provider must:
In addition the provider should:
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Undertake the planned work to improve the practice premises.
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The infection prevention and control audit action plan should be updated to reflect work completed in order to ensure effective oversight of improvement activity.
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The practice’s meeting structure should include all staff roles to facilitate effective communication and information flow.
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The process for disseminating learning outcomes following investigation of incidents should be formalised and embedded into practice.
I am taking this service out of special measures. This recognises the improvements made to the quality of care provided by the service.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice