All inspections: Ashton Medical Group - Care Quality Commission

We carried out an announced inspection at Ashton Medical Group on 13 August 2021. Overall, the practice is rated as good.

The ratings for each of the key questions are:

Safe – good

Effective - good

Caring - good

Responsive - good

Well-led – good

Following our previous inspection on 29 October 2019, the practice was rated Requires Improvement overall with the following ratings for each of the key questions:

Safe - good

Effective – requires improvement

Caring - good

Responsive - good

Well-led – requires improvement

We issued a requirement notice in respect of a breach of Regulation 17 (good governance) of the Health and Social Care Act (Regulated Activities) Regulations 2014.

At this inspection on 13 August 2021 we inspected the key questions safe, effective and well-led. We rated these as good. The previous ratings of good for the key questions caring and responsive remain in place.

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

Why we carried out this inspection

This inspection was a focused inspection to follow up on the breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 found in the inspection of 29 October 2019, and to be able to change the rating of the practice as appropriate.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

Conducting interviews using video conferencing
Completing clinical searches on the practice’s patient records system and discussing findings with the provider
Reviewing patient records to identify issues and clarify actions taken by the provider
Requesting evidence from the provider
A site visit with minimum time spent on site

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 have rated this practice as good overall and good for all population groups.

We rated the practice good for providing safe services because:

The practice provided care in a way that kept patients safe and protected them from avoidable harm.

We rated the practice good for providing effective services because:

Patients received effective care and treatment that met their needs. Improvements had been made as follows:
- A new system was in place to ensure monitoring of the outcomes for people with long term conditions and those with poor mental health.
- Quality Outcomes Framework data was now above average or in line with local and national averages for patients with long term conditions.

The rating of good for the key question caring remained in place from the previous inspection.

The rating of good for the key question responsive remained in place from the previous inspection.

We rated the practice good for providing well-led services because:

The way the practice was led and managed promoted the delivery of high-quality, person-centre care. Improvements had been made as follows:
- The practice had embedded clear processes for managing risks, issues and performance.
- The practice installed a secure web-based management tool which enabled partners and managers to have real-time oversight of risk and performance.
- The practice had implemented improvement plans, including the introduction of a new telephone system and online consultations.
The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.

All areas requiring improvement had been acted upon and monitored.

Whilst we found no breaches of regulations, the provider should:

Increase the number of women attending cervical screening appointments.
Review oversight of patients prescribed high risk medicines whose monitoring has been postponed during the COVID-19 pandemic.

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

We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

This inspection focused on the following key questions: are services effective, responsive and well-led

Because of the assurance received from our review of information we carried forward the ratings for the following key questions from the previous inspection: are services safe and caring.

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 and requires improvement for people with long term conditions and people experiencing poor mental health.

We found that:

Patients in the main received effective care and treatment that met their needs. However, the recall system was ad-hoc and not all patients had had an annual review in line with good practice.
Staff dealt with patients with kindness and respect and involved them in decisions about their care.
The practice organised and delivered services to meet patients’ needs. Improvements had been made to the way patients could access care and treatment.
The practice proactively sought feedback from staff and patients, which it acted on.
The way the practice was led, and managers promoted the delivery of person-centre care.

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

There was limited monitoring of the outcomes for patients with long term conditions.
Quality Outcomes Framework data was significantly below local and national averages for patients with long term conditions.

We rated the practice as good for responsive services because:

The practice organised and delivered services to meet patients’ needs. There was a diverse skill mix of clinical staff to respond to patient’s needs, including those patients who required care at home.
In partnership with Community Wellbeing Tameside and Glossop the practice has recruited a team of 13 volunteer patient champions. The patient champions are able to offer waiting room support by directing patients to the right location and helping them to check in. They have also set up a monthly walking group, for patients of all abilities.

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

The practice processes for managing risks, issues and performance, were unclear and inconsistent.

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.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

Review safety net arrangements for reviewing results received whilst a GP is away from the practice.
Review data for childhood immunisations and look to implement systems to achieve targets.
Ensure there is a record of GPs completing level three safeguarding training and a record of DBS checks having taken place where required.
Continue to monitor improvements made to the telephone and appointment system.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief

Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the practice of Bedford House Medical Centre on 16 November 2016. Overall the practice is rated as good.

The practice had been previously inspected on 8 April 2015. Following that inspection the practice was rated as requires improvement with the following domain ratings:

Safe – Requires Improvement

Effective – Requires improvement

Caring – Good

Responsive – Good

Well led – Requires improvement.

The practice provided us with an action plan detailing how they were going to make the required improvements.

The inspection on 16 November 2016 was to confirm the required actions had been completed and award a new rating if appropriate.

Following this re-inspection on 16 November 2016, our key findings across all the areas we inspected were as follows:

Our key findings across all the areas we inspected were as follows:

Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
Risks to patients were assessed and well managed, including those relating to recruitment checks.

Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

Data showed patient outcomes were mixed compared to those locally and nationally.
Feedback from patients about their care was strongly positive,

Patients said they were in the main treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

The practice implemented suggestions for improvements and made changes to the way it delivered services as a result of feedback from patients.

Information about services and how to complain was available and easy to understand.

Patient’s views were mixed when asked how easy it was to make an appointment including availability of same day appointments. The practice in response to patient feedback had introduced a new triage system as a means of improving access.

The practice had good facilities and was well equipped to treat patients and meet their needs.

There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Bedford House Medical Centre on 8 April 2015. We found the practice was performing at a level which led to a ratings judgement of requires improvement.

Specifically, we found the practice to be good for providing caring and responsive services. It requires improvement for providing a safe, effective and well led service for the population groups we assess.

Our key findings were as follows:

Staff spoken with told us information about safety incidents was recorded and discussed during weekly meetings.
Staff knew to report concerns about patients’ safety to a senior member of staff.
Some improvements were needed to the way medicines were managed.
Systems were in place to prevent and protect people from health-care associated infections.
A range of policies and procedures were in place to support staff in their role.
Patients with long term conditions were monitored annually for medicines or more often if needed.
Patients were positive about the service they experienced. Patients said the practice offered an excellent service and the reception staff were helpful and polite. They said the GPs listened to what they had to say and offered excellent care.
The CQC patient comment cards returned to us indicated that patients felt reassured by the GPs who cared for them.
A complaint policy was available to patients so they knew what to do if they were unhappy with the service provided.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

Ensure medicines are managed safely.
Ensure thorough staff recruitment procedures are followed when employing new staff.
Ensure governance systems are in place that bring about improvements to the service.

In addition the provider should:

Ensure a full cycle of clinical auditing takes place to ensure positive outcomes for patients.
Ensure a full cycle of auditing takes place in relation to significant events to ensure positive outcomes for patients.
Ensure all staff are aware of the whistleblowing policy to provide them with a way of reporting concerns anonymously.
Ensure a full infection control audit is completed to assess systems in place for maintaining safe standards of hygiene in the practice.
Ensure the record of checks made on the oxygen cylinder includes information about identifying potential faults.
Ensure administrative staff are provided with an annual appraisal so they have opportunity to discuss their work and set targets for the future development of their role.
Ensure the patient appointment system is reviewed so that patients are not directed to the local walk-in centre.
Ensure patients with a learning disability are offered an annual health check.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Archived: Ashton Medical Group

All Inspections

13 August 2021

During an inspection looking at part of the service

29 October 2019

During an inspection looking at part of the service

16/11/16

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)

8 April 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)