Background to this inspection
Updated
9 March 2020
Burnett Edgar Medical Centre is registered with the Care Quality Commission to provide primary care services. The practice provides services to approximately 4,357 patients from one location at Central Drive, Walney Island, Barrow In Furness, Cumbria, LA14 3HY.
The practice is based in a purpose-built surgery which opened in 1989. It has level-entry access and a car park for patients to use. It is the only GP practice on Walney Island and the majority of the patient population live on the island.
The practice has 12 members of staff, including two GP partners (both male), one long-term locum GP (female), one practice nurse (female), two healthcare assistants (one of whom is also a secretary), a practice manager, a medicines manager/receptionist, a secretary and three reception staff.
The practice is part of Morecambe Bay clinical commissioning group (CCG). Information published by Public Health England, rates the level of deprivation within the practice population group as four on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. The practice population generally reflects the national average in terms of age distribution.
The surgery is open from 8.30am to 8.45pm on Monday and 8.30am to 6.30pm Tuesday to Friday. Telephones are answered from 8am until closing time, Monday to Friday.
The practice provides services to patients of all ages based on a General Medical Services (GMS) contract agreement for general practice. The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and Cumbria Health On Call (CHOC).
The practice is registered with CQC to provide treatment of disease, disorder or injury, family planning services, surgical procedures and diagnostic and screening procedures as their regulated activities.
Updated
9 March 2020
We carried out an announced comprehensive inspection at Burnett Edgar Medical Centre on 16 November 2018 as part of our inspection programme. We rated the practice as requires improvement for providing safe services and good overall.
The full comprehensive report on the November 2018 inspection can be found by selecting the ‘all reports’ link for Burnett Edgar Medical Centre on our website at www.cqc.org.uk.
At our inspection in November 2018 we rated the practice as requires improvement for providing safe services because:
- Records of staff training were incomplete, and some staff had not undertaken training according to practice policy.
- The practice clinical audit programme was in need of review to ensure it was appropriate for the needs of the practice.
We also indicated improvements should be made as follows:
- Perform an analysis of themes from significant events to look for trends;
- Include details of safeguarding procedures in the locum pack.
On 17 January 2020, we carried out a focused, desk-based inspection of the safe key question. We reviewed evidence submitted by the practice to confirm it had carried out the plan to meet the legal requirements in relation to the breaches in regulations identified in our previous inspection on 16 November 2018. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
At this inspection, we found that the provider had satisfactorily addressed all legal requirements and suggestions for improvements.
We have rated this practice as good for providing safe services.
We found that:
- Adherence to practice policy and procedure in relation to staff training was improved. Staff and GPs had generally undertaken required annual training and there were comprehensive records of this in place.
- We saw evidence staff were appropriately trained for safeguarding patients and safeguarding information had been included in the GP locum pack.
- There was evidence of an audit programme appropriate to the needs of the practice.
- The management of significant events had improved, and we saw learning was shared routinely with staff.
Whilst we found no breaches of regulations, the provider should:
- Ensure all staff and GPs follow the practice protocol for undertaking annual practice mandatory training in all areas, including fire training.
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