Peak & Dales Medical Partnership Also known as Bakewell Medical Centre

We carried out an announced comprehensive inspection at Peak & Dales Medical Partnership on 10 and 14 August 2023. Overall, the practice is rated as requires improvement. We rated the practice as requires improvement for the key questions safe, effective and well-led and good for caring and responsive.

Following our previous inspection on 7 February 2020, the practice was rated outstanding overall and in the key questions responsive and well-led. It was rated good in the key questions safe, effective and caring.

At the last inspection we rated the practice as outstanding for providing responsive and well-led services because:

• The practice could demonstrate how the needs of families, children and younger people, and those whose circumstances made them vulnerable, were paramount to how they adapted service delivery and fulfilled the needs of these groups of people.
• There was evidence of proactive, effective and strong leadership. There were systems in place to drive internal improvements, quality initiatives, innovation and a commitment to engage with others and share best practice.

At this inspection, we found that those areas previously regarded as outstanding practice were now embedded throughout the majority of GP practices. At this inspection, we found some areas of concern and that the threshold to achieve an outstanding rating had not been reached. The practice is therefore now rated requires improvement for providing safe, effective and well-led services and good for providing responsive and well-led services.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Peak & Dales Medical Partnership on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up concerns reported to us.

• We inspected the key questions safe, effective, caring, responsive and well-led.
• We followed up on the 3 best practice recommendations identified at our previous inspection.

How we carried out the inspection.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews using video conferencing.
• Staff questionnaires.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A site visit.
• Speaking with a member of the Patient Participation Group
• Speaking with representatives of 3 care homes where the practice provided care and treatment.
• We visited both practices as part of this inspection.

Our findings

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 rated the practice as requires improvement for providing a safe service because:

• The provider had not ensured that all of the required recruitment checks or documents were available for each person employed.
• Risk assessments had not been completed for staff without a Disclosure and Barring Service (DBS) check in place, to determine the frequency of repeating DBS checks or for staff who had not received the required vaccinations or acquired immunity.
• All of the suggested emergency medicines were not available at the Bakewell Practice and a risk assessment to mitigate potential risks had not been completed.
• Checks and recording of fridge and cool bag temperatures to mitigate potential risks of delivering vaccines outside of the manufacturer’s guidance had not always been completed in line with the practice’s cold chain policy.
• Our clinical searches identified small numbers of patients that had not received the required blood test monitoring for medicines that require monitoring checks and that Medicines and Healthcare products Regulatory Agency (MHRA) alerts had not always been acted on.
• Opportunities to raise significant events had been missed.

However, we found that:

• The best practice recommendation that non-clinical staff should update their child safeguarding training to level 2, in line with updated guidance, had been completed.

We rated the practice as requires improvement for providing an effective service because:

• Patients with potential diabetes had not always been reviewed or followed up in line with national guidance to prevent long-term harm.
• Some staff had not received a timely appraisal.

However, we found that:

• The best practice recommendation to improve uptake rates for childhood immunisations had been completed.
• Staff had the skills and knowledge to carry out their roles.

We rated the practice as good for providing a caring service because:

• Feedback from patients regarding care and treatment was very positive and this was supported by the national GP survey data.
• Feedback from patient regarding end of live care was extremely positive, they stated that GPs went over and above their expectations.

We rated the practice as good for providing a responsive service because:

• The practice understood the needs of its local population and had developed services in response to those needs.
• Patients had timely access to appointments. Feedback from parents was particularly positive about access to appointments for children.

However, we found that:

• The best practice recommendation that the practice should improve the process for responding to official complaints had not fully been completed.

We rated the practice as requires improvement for providing a well-led service because:

• There were governance systems in place, however they did not always work effectively. Policies were not always updated in a timely manner. Policies were not always adhered to in particular, responding to complaints, cold chain management and recruitment of staff.
• It was not always clearly documented what the learning from significant events and complaints was or how it was shared with staff to drive improvements. Opportunities to raise significant events had been missed.

However. we found that:

• There was a clear vision, strategy and succession planning within the practice.
• Staff reported that they felt able to raise concerns without fear of retribution.

We found 2 breaches of regulations. The provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, the provider should:

• Complete action plans to address and monitor any issues identified in the planned 5 year electrical installation conditions reports.
• Embed into practice the monthly fire hazard checks and assess when repeat fire risks assessments are required.
• Provide patients with asthma that have been prescribed 2 or more courses of rescue steroids with steroid cards.
• Embed into practice that blood test results have been checked and recorded in patients’ records before issuing repeat prescriptions for medicine’s that require monitoring.
• Review clinical audits to assess if changes made as a result of the findings have been effective.
• Provide all staff with regular appraisals.

We found one area of outstanding practice:

• One of the GP partners was the clinical lead for end of life care for East Midlands. They had used their experiences of providing end of life care within the practice to drive changes in the Midlands region by leading on the development of the Midlands One Care Plan. This end of life care plan will be a unified plan across the whole of the Midlands and available on the NHS App for patients to download and share with care staff. Feedback from patients was extremely positive about the end of life care they and their relatives had received.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care