The Care Quality Commission
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  • GP practice

Alkrington Junction Practice

Overall: Requires improvement read more about inspection ratings

346 Grimshaw Lane, Middleton Junction, Middleton, Manchester, Greater Manchester, M24 2AU (0161) 271 3030

Provided and run by:
The Junction Alkrington Surgery

All Inspections

08 June 2023

During a routine inspection

We carried out an announced comprehensive inspection at Alkrington Junction Practice on 8 June 2023. Overall, the practice is rated as requires improvement.

Safe - requires improvement

Effective – requires improvement

Caring - good

Responsive – requires improvement

Well-led – good

This provider was previously inspected on 23 January 2017, the practice was rated good overall and good for all key questions.

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

Why we carried out this inspection

We carried out this inspection to follow up concerns identified during our monitoring process.

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.
  • Reviewing completed questionnaires sent to staff prior to the on-site visit
  • 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 short site visit.

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 requires improvement overall.

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

  • Aspects of medicines management which included the management of patients prescribed some high-risk medicines, medicines reviews and medicines usage were not always effective.

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

  • The management of patients with some long-term conditions was not always in line with guidance.

We have rated this practice as requires improvement for responsive because:

  • Aspects of patient satisfaction are below the local and national averages.

We found that:

  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • Patients could access care and treatment in a timely way.
  • Patients were not always provided with care in a way that kept them safe and protected from the risk of harm.
  • Patients did not always receive effective care and treatment that met their needs.

We found one breach of regulations. The area where the provider must make improvements are:

  • Provide care and treatment in a safe way to patients.

We have told the provider they should:

  • Give staff access to a Freedom to Speak Up Guardian
  • Analyse and improve national patient survey results
  • Maintain record of staff immunisations

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

23 January 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Junction Alkrington Surgery on 23 January 2017. Overall the practice is now rated as good.

The practice had been previously inspected on 8 June 2016. Following that inspection the practice was rated as requires improvement with the following domain ratings:

Safe – Inadequate.

Effective – Good.

Caring – Good

Responsive – Requires improvement

Well Led - Requires improvement

  • The practice did not ensure that adequate recruitment checks were carried out
  • They did not carry out regular health and safety and infection control risk assessments and procedures were not in place to manage risks.
  • Not all staff received training linked to their roles and responsibilities or had appraisals.

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

The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for The Junction Alkrington Surgery on our website at www.cqc.org.uk.

The full comprehensive inspection on 23 January 2017 was to confirm the required actions had been completed and award a new rating if appropriate. Following this re-inspection, our key findings across all the areas we inspected were as follows:

Since the last inspection the practice had made the following improvements:

  • The practice had implemented a new policy to carry out all recruitment checks when employing new members of staff. All current members of staff had received a check with the Disclosure and Barring Service.
  • A member of staff had been delegated as infection control lead and had carried out an infection control audit and all identified risks had been actioned.
  • A health and safety policy had been implemented and a recent audit carried out.
  • The use of an autoclave used to sterilise equipment had ceased and the practice was now using single use medical equipment.
  • Systems were implemented to ensure that all medicines, vaccinations and clinical supplies were within their expiry date.
  • The transport of and use of liquid nitrogen had been suspended until training in the use of hazardous substances had been carried out.

Other key findings were as follows:

  • The practice had a systematic process of dealing with and monitoring updates and guidelines from the National Institute for Health and Care Excellence (NICE).
  • Feedback from patient surveys and Family and Friends test were consistently positive about the practice. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

  • The practice had set set up a befriending service where volunteer members of the patient participation group worked with the Royal Voluntary Service and went to meet patients on the day that they were discharged from hospital and offered ongoing support. The practice told us that the scheme had helped to reduce re-admission rates when deployed elsewhere in the country.
  • The practice offered a Telephone Crisis Brief Intervention Scheme where patients were able to telephone the surgery and a mental health worker, employed by the practice, would offer advice. This scheme resulted in a reduction of patients attending A&E departments and walk in centres.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

8 June 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Junction Alkrington Surgery on 8 June 2016. Overall the practice is rated as requires improvement.

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

  • Risks to patients were not always assessed and well managed including those relating to recruitment checks, infection control and health and safety.
  • An autoclave was in use to sterilise minor surgery and other equipment. There was no system for traceability, no checks were made on the effectiveness of the sterilisation process.
  • Patients said they found it difficult to get through to the surgery by telephone and 59% of patients were able to get an appointment to see or speak to someone the last time they tried compared to the national average of 76%.
  • Patients said they were treated with 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.
  • There was an open and transparent system in place for reporting and recording significant events.
  • Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses.
  • Urgent appointments were usually available on the day they were requested.
  • The practice had an active patient participation group.
  • The practice had a good skill mix which included a team of mental health workers and counsellors offering one to one counselling and group therapy.

The areas where the provider must make improvements are:

  • Ensure adequate recruitment checks take place including a full employment history and proof of identity for all staff.
  • Ensure regular health and safety risk assessments are carried out, and that procedures are in place to manage risks..
  • Ensure regular infection control audits are carried out.
  • Ensure all staff receive training linked to their roles and responsibilities and have appraisals.

In addition the provider should:

  • Improve their procedures for identifying issues and making improvements to the service provided.

However we did see areas of outstanding practice:

  • The practice had set up a befriending service where volunteer members of the patient participation group worked with the Royal Voluntary Service and went to meet patients on their day of discharge and offered ongoing support. The scheme had helped reduce re-admission rates.
  • The practice offered a Telephone Crisis Brief Intervention Scheme where patients were able to phone the surgery and the mental health worker would offer advice. This helped reduced the number of patients attending A&E departments and walk in centres

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

4 June 2014

During an inspection looking at part of the service

We undertook a follow up inspection to The Junction Alkrington Surgery on the 4 June 2014.

We did not speak to people who used the service during this inspection.

We found that since our last inspection the registered provider was now operating a robust recruitment process and one that fully protected patients.

We found that since our last inspection the registered provider had listened to patient feedback and had taken action to improve the quality of the service provided to patients.

20 January 2014

During a routine inspection

During our inspection we found that the provider carried out their regulated activities from two locations but had only registered one of these locations with the Care Quality Commission. We told the provider that they were currently not registered to carry out regulated activities from the additional location and they must apply to add this to their registration immediately.

All consultation rooms were accessible to patients using a wheelchair or pushing a pram.

No early morning or late night appointments were available but patients could access late night and weekend appointments at a nearby medical practice. Drugs and equipment were available for use in a medical emergency.

All areas of the practice were visibly clean. There was a cleaning schedule in place and the cleaner signed to confirm each task had been completed.

The practice did not follow the procedures set out in its recruitment policy. Disclosure and barring service (DBS) checks had not been carried out for relevant staff, and the work history of staff was not checked.

Some clinical audits took place but the provider did not have a system in place to monitor the quality of the service provided or assess the satisfaction of patients.

Patients told us they were treated respectfully and felt involved in decisions about their care. Some told us they had difficulty accessing appointments and had difficulty getting through to the practice on the telephone.