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Dr McManus and Partners Good Also known as Weavers Medical

Reports


Inspection carried out on 26 February 2020

During an inspection looking at part of the service

Weavers Medical had been inspected previously on the following dates: -

2 October 2014 under the comprehensive inspection programme. The practice was rated as Good overall

3 July 2019 we carried out an announced focussed inspection. This was as a result of the Care Quality Commissions annual regulatory review. We inspected the domain areas of, effective and well led. During the inspection due to concerns we found we added a further key question of safe which resulted in the practice being rated as requires improvement overall. Safe and effective were rated as requires improvement. Well-led was rated as inadequate and the populations groups were rated as requires improvement. We served a warning notice in relation to Regulation 17 Good Governance which required the practice to be compliant by 4 October 2019.

We carried out an announced comprehensive inspection at Weavers Medical on 26 February 2020 as part of our inspection programme. We also looked at the breaches covered in the warning notice for Regulation 17, Good Governance, served in July 2019.

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.

We rated the practice as Good for providing a Safe service because:-

  • At this inspection we found that the practice had made improvements to the systems it had in place for patient safety alerts, management of high-risk medicines and medication reviews.

We rated the practice as Requires Improvement for providing Effective services and for four out of the six population groups because:-

  • The population groups of people with long term conditions, families, children and young people, working age people (including those recently retired and students) and people experiencing poor mental health (including people with dementia) were rated as requires improvement because :-
  • The practice has not met the minimum 90% for three of four childhood immunisation uptake indicators.
  • The percentage of women eligible for cervical screening was below the national average of 80%.
  • Exception reporting for patients with long term conditions, mental health and dementia were above the CCG and national averages.
  • People were not always able to access care and treatment in a timely way.

We rated the practice as Good for providing a Caring and Responsive service because:-

  • Staff treated patients with kindness, respect and compassion. Feedback from patients was positive about the way staff treated people.

We rated the practice as Good for providing a well-led service because we found:-

  • The management team had made a number of improvements and had achieved compliance for the warning notice. However , there were still some areas of governance that needed strengthening.

The areas where the provider must make improvements 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 improvements:-

  • Improve patient satisfaction for appointments and the ability to access the practice by telephone.

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

Overall summary

Inspection carried out on 3 July 2019

During an inspection looking at part of the service

Weavers Medical had been inspected previously on the following dates: -

2 October 2014 under the comprehensive inspection programme. The practice was rated as Good overall

We carried out an announced focussed inspection at Weavers Medical on 3 July 2019 as part of our inspection programme. As part of the Care Quality Commission annual regulatory review we inspected the domain areas of, effective and well led and during the inspection due to concerns found we also inspected the safe domain.

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 Requires Improvement overall.

We rated the practice as Requires Improvement for providing a Safe

service because we found:-

  • The practice did not have systems for the appropriate and safe use of medicines, including medicines optimisation.
  • Staff did not always have the information they needed to deliver safe care and treatment.
  • The practice learned and made improvements when things went wrong .

We rated the practice as Requires Improvement for providing Effective services because we found:-

  • Patients’ needs were not always assessed, and care and treatment was not always delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
  • Quality improvement had been carried out but we saw limited evidence that audits were driving improvements to patient outcomes.
  • The practice was able to demonstrate that staff had the skills, knowledge and experience to carry out their roles.

We rated the practice as Inadequate for providing a well-led service because we found:-

  • Some of the systems and processes in place were not established or operated effectively to ensure compliance with good governance.

The areas where the provider must make improvements 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 improvements are:

  • Ensure meeting minutes include details of discussion that have taken place in regard to significant events and learning and actions required are shared with the practice team.
  • Maintain a register of the immunisation of all staff in line with Public Health England guidance relevant to their role.
  • To strengthen the system for clinical audits and include more structure and a fuller analysis to ensure quality improvement.
  • Continue to monitor and improve patient satisfaction in respect of access to the service, in particular, the improvement of telephone access and appointments.

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

Inspection carried out on 02 October 2014

During a routine inspection

We inspected Dr Balloch & Partners on 2 October 2014, as part of our new, comprehensive inspection programme. The practice had not previously been inspected.

The overall rating for this practice is good. We found the practice to be effective, caring, responsive to people’s needs and well-led. The quality of care experienced by older people, by people with long-term conditions, families, children and young people was good. Working age people (including the recently retired and students), those in vulnerable circumstances and people experiencing poor mental health also received good quality care.

Our key findings were as follows:

  • The practice was a friendly, caring and responsive practice that addressed patients’ needs and worked in partnership with other health and social care services to deliver individualised care.
  • There was a good range of appointments available for patients through extended opening hours, visits to local care homes and appointments at home for other patients who were unable to travel to the practice.
  • The practice ensured learning from incidents and events through discussion, analysis and the cascading of the findings to the appropriate staff.
  • Staff were supported to do their jobs through a system of regular appraisal and supervision. GP trainees were well supported to develop their practice.
  • The practice was visibly clean and regularly audited to ensure the risks of the spread of infection were minimised.
  • The practice actively participated in the local safeguarding children board and the lead GP attended meetings set up under the statutory framework for reviewing serious child protection cases.
  • There was a clear culture of learning, improvement and innovation amongst staff who were supported by the open door policy operated throughout the practice.

We saw several areas of outstanding practice:

  • Whenever GPs at the practice referred patients onwards for specialist treatment, every referral was subject of a peer-to-peer discussion with another doctor to ensure that the treatment pathway was appropriate to the particular patient’s needs. Thereafter the outcome of the referral was considered in the same way by both the requesting and reviewing doctor to ensure that the patient’s needs had been met and to take any mutual learning from it.

  • The practice took a proactive approach to identifying potential safeguarding concerns regarding children. Notes for new patients and those attending accident and emergency, out of hours and urgent care services were scrutinised for any suggestion of safeguarding issues. If children failed to attend hospital appointments and parents declined an offer to rebook the GP would review the circumstances and make a safeguarding referral if they judged it appropriate to do so.

  • The practice shared its learning and innovation with other practices in the CCG local area. This included the nurse-led review of COPD medication which resulted in positive outcomes for patients and significant cost savings for the practice. The nurse safeguarding lead was also accessible to other practices in order to share knowledge, expertise and provide support. An information sheet designed by a GP partner to be included in the personal child health record gave information on how to use health services appropriately when a child is unwell, such as calling a pharmacist or the GP instead of visiting accident and emergency. Subsequently the local CCG funded production of the sheets and recommended their use across the whole CCG area.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice