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Inspection Summary

Overall summary & rating


Updated 12 March 2020

We undertook an inspection of this service on 20 February 2020. At our previous inspection in March 2019, we rated the practice as good overall and requires improvement for providing safe services. We issued the practice with a breach of regulation 17 (good governance). This inspection was to follow up on the breach of regulation identified at our previous inspection in March 2019 and we looked at the safe key question only.

Our judgement of the quality of care at this service is based 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.

At the previous inspection, we rated the practice as requires improvement for providing safe services because:

  • We found out of date medicines in the emergency medicine kit. The practice did not stock atropine, an emergency medicine recommended for practices that fit coils. At all sites, the practice kept glucagon in the emergency kit; it was not refrigerated, and the date of when it was taken out of the fridge was not recorded, nor was the new expiry date. After the inspection, the practice sent an updated protocol for the management of the emergency kit.

At this inspection, we rated the practice as good for providing safe services and found these issues had been rectified.

We have rated this practice as good overall.

At this inspection we found that the provider was proving safe services because:

  • The emergency medicines stocked in the practice were appropriate and within their expiry date. Where medicines were not stocked, there was an appropriate risk assessment in place.

In addition, we found that the practice had made improvement to areas identified at our last inspection where the practice should make improvements:

  • The practice had improved their Quality and Outcomes Framework (QOF) achievement and were in line with averages for indicators relating to diabetes, chronic obstructive pulmonary disease (COPD) and mental health. We viewed data for 2019/20 and found the practice was on a positive trajectory.

  • The practice had identified 151 patients with a learning disability. The practice had two named learning disability lead nurses and offered double appointments for reviews. An annual review had been completed for 82 patients. We saw that 10 patients were booked in for a review and 31 patients had declined a review. The practice was in the process of contacting the other patients. Where patients had declined a review, the practice liaised with the learning disabilities team to ensure the team were aware of these patients. They had also contacted a local learning disabilities nurse to give training to staff and raise awareness of the needs of these patients. They had worked with a local hospital to flag any patients that had not attended for cancer screening and reviewed these patients. The practice had a service development group, including members of staff from all groups and the patient participation group (PPG), and had invited a learning disabilities charity to attend the group to give advice on the management of patients with autism. They were in the process of advertising “quiet hours” for a local supermarket on their website, for patients who may benefit from this.

  • The practice had recognised and prioritised carers and their health and wellbeing within their population group. The practice had drafted a declaration on how to identify and support carers which was in line with NHS England quality markers and best practice. This had been devised in the service development group with the patient participation group and the carers lead from the local hospital for a full multidisciplinary team approach. The practice had invited representatives from local young and older carers charities to join the Practice Carers Group and representatives were due to attend the next meeting. The practice had designed a poster to inform patients on what defines a carer and ensured patients had access to a carers’ handbook. They had identified 800 patients as carers (3.2% of the practice population), which was a marked improvement from our last inspection where the practice had identified 71 patients as carers. The practice had achieved this with a whole team approach, changing their registration forms and updating clinical templates to remind clinicians to ask patients if they were a carer. The practice told us they had reviewed the list and had removed 32 patients as they were no longer carers and strived to ensure the list was accurate. The practice had set up carers health checks and had offered 50 of these to patients and had also administered 298 flu vaccines to carers. The practice had identified 10 young carers and worked with the local young carers charity representative to offer them care and support. The practice had a team approach to managing carers and had a carers champion in place and a lead GP for carers. There was a board in reception for carers including posters and carers information and the website linked to national carers websites. In conjunction with the PPG, the practice were setting up events for national carers week and were planning a regular carers support group. Carer awareness was also included in the practice induction and was part of all staff training. The practice also had a carers employment policy to support any staff with caring responsibilities.

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

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of General Practice

Inspection areas










Checks on specific services

People with long term conditions


Families, children and young people


Older people


Working age people (including those recently retired and students)


People experiencing poor mental health (including people with dementia)


People whose circumstances may make them vulnerable