Parbold Surgery

Updated 1 September 2021

arbold Surgery (The Green, Parbold, Wigan, WN8 7DN) occupies purpose-built premises close to the centre of the village of Parbold. Ample car parking facilities are available outside the building. The practice provides services to a patient list of approximately 7000 patients via a general medical services contract with NHS England. It is part of the NHS West Lancashire Clinical Commissioning Group (CCG).

Male and female life expectancy (80 and 82 years respectively) for the practice population is slightly above local and national averages for males (both 79 years) and slightly below local and national averages for females (both 83 years). The practice’s patient population consists of a slightly higher proportion of older people, with 25.6% being over the age of 65 (CCG average 22%, national average 17.3%), and 11.2% being over the age of 75 (CCG average 10%, national average 7.8%).

Information published by Public Health England rates the level of deprivation within the practice population group as seven on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

The practice is staffed by five GP partners (two female and three male). The GPs are supported by a practice nurse (female) and three health care assistants. The clinical staff are supported by a practice manager, assistant practice manager and a team of administration and reception staff.

The practice is a training practice for GP registrars.

The practice is registered with CQC to provide the regulated activities diagnostic and screening procedures, treatment of disease disorder and injury, maternity and midwifery services and surgical procedures.

Due to the enhanced infection prevention and control measures put in place since the pandemic and in line with the national guidance, most GP appointments were telephone consultations. If the GP needs to see a patient face-to-face then the patient is offered one.

Extended access is provided locally by West Lancashire GP Federation where late evening and weekend appointments are available. Out of hours services are provided by NHS 111.

Updated 1 September 2021

We carried out an announced inspection at Parbold Surgery on 28, 29 and 30 July 2021. Overall, the practice is rated as Good.

The key question ratings are as follows:

Safe - Good

Effective - Good

Caring – not inspected (Good rating carried forward from previous inspection)

Responsive – not inspected (Good rating carried forward from previous inspection)

Well-led - Good

Following our previous inspection on 10 September 2019, the practice was rated requires improvement overall and requires improvement for safe services, inadequate for Well led services and good for the remaining key questions. We issued the practice with a warning notice as enforcement for breaches of regulations. We carried out an inspection to follow up on the warning notice on 20 February 2020, we were assured during the visit that those breaches of regulation had been addressed.

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

Why we carried out this inspection

This inspection was a comprehensive inspection to follow up on breaches of regulations identified at the previous inspections and areas identified that the provider should focus on.

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 staff 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 short site visit on 30 July 2021.
• Speaking with a member of the PPG (patient participation group) over the telephone to consult on the service provided.

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 found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm. We noted some prescribing was not in line with best practice. The provider sent us evidence the following day to demonstrate that they had taken steps to resolve these issues. Letters had been sent to the small number of patients effected to arrange medication reviews. There was no evidence of any harm having come to patients.
• We noted that safety alerts were not always well recorded, and some historic alerts had not been acted on. We were sent evidence the day after the inspection assuring us that work was underway to consolidate protocols for recording and dealing with alerts, any historic alerts were being reviewed and acted upon.
• Patients received effective care and treatment that met their needs, however there was some inconsistency in the documenting of patient notes and medication reviews.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Staff spoke highly of the management team and described an excellent working environment.
• 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.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• Access to the practice was assessed as excellent by patients.

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

• Develop a single comprehensive record for safety alerts and review any that may not have been appropriately dealt with.
• Continue to embed new higher risk medicines protocols.
• Develop a more consistent approach to documenting care plans and medication reviews.

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

Updated 1 September 2021

Updated 1 September 2021

Updated 1 September 2021

Updated 1 September 2021

Updated 1 September 2021

Updated 1 September 2021