West Wirral Group Practice - AR Johnston

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at West Wirral Group Practice - AR Johnston on 19 April 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety. Systems were in place for reporting, recording and learning from accidents, significant events and untoward incidents. Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses.
• Staff had received training in safeguarding and protection of children and vulnerable adults however in some cases clinical staff had not received a level of safeguarding children training that was appropriate to their role. Local authority guidance and protocols were accessible and staff were aware of how to raise concerns. Local practice safeguarding policies and procedures needed updating to reflect relevant national guidance.
• Recruitment policies and procedures did not reflect relevant legislation and guidance and recruitment records did not contain all the required information to be held in respect of people employed at the practice.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

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

• Information about services and how to complain was available and easy to understand.
• Patients said they did not always find it easy to make an appointment with a named GP and there was a lack of continuity of care.
• The practice had good, modern 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 provider was aware of and complied with the requirements of the Duty of Candour.
• There was a lack of robust governance arrangements in place. There was not an effective system in place to act on patients’ feedback. Risks relating to maintenance and storage of staff records including information relevant to their employment within their role were not well managed. Audits did not demonstrate improvements to care and treatments and were not widely shared for staff to learn from them.
• The practice had a number of policies and procedures to govern activity, but some needed to be reviewed to reflect current guidance and legislation. For example safeguarding and recruitment policies and procedures.
• Risks to patients were generally assessed and managed. However general environmental risk assessments and fire risk assessments needed updating.
• There was a lack of a robust training plan for the practice to ensure all staff received required training at appropriate levels and frequency.

The areas where the provider must make improvements are:

• Ensure an effective audit programme is implemented to assess, monitor and improve the quality and safety of services.

• Ensure an effective system is established to assess, monitor and mitigate the various risks arising from undertaking of the regulated activities.

• Ensure an effective system is implemented by which patient views are analysed, acted on and feedback used to help improve services.

• Ensure all staff are trained to an appropriate level for their role in safeguarding of children and protection of vulnerable adults.

• Ensure records relating to staff include information relevant to their employment in the role including information relating to the requirements under Regulations 4 to 7 and Regulation19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in particular Disclosure and Barring Service checks relevant to the role.

• Ensure records relating to staff are stored safely and securely in accordance with current legislation and guidance.

• Ensure their audit and governance systems remain effective.

In addition the provider should:

• Review the practice’s policies and procedures including safeguarding, recruitment and infection control policies and procedures, to ensure they are up to date with current guidance.

• Review the process for learning from significant events and complaints to include regular reviews to learn from themes and trends and to monitor completion of action plans.

• Review the arrangements in place for receiving and recording the response to patient safety alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS), as well as from other relevant bodies such as, Public Health England (PHE).

• Review the format of staff meetings to include documented dissemination of lessons learnt from significant incidents, events and complaints and sharing improvements from audits and patient feedback.

• Review the frequency of which infection control audits are undertaken to ensure action plans are completed.

• Review, document and display the cleaning schedule and ensure cleaning equipment is stored appropriately.

• Review the training, learning and development needs of staff members at appropriate intervals and establish an effective process for the on-going assessment and supervision of all staff employed which includes ensuring staff are up to date with mandatory training including safeguarding, infection control.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice