Archived: Maghull Practice

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Maghull Practice. The practice is registered with the CQC to provide primary care services. We undertook a planned, comprehensive inspection on 20 November 2014 and we spoke with patients, relatives, staff and the practice management team.

The practice was rated as Requires Improvement.

Our key findings were as follows:

• There were aspects of the service that needed improvement. The practice had a good track record for maintaining patient safety. Incidents and significant events were identified, investigated and reported, though improvements were required for the reporting of incidents. Lessons learnt were disseminated to staff. Improvements were required to ensure staff were safely recruited and records were maintained.
• There were some systems in place which supported GPs and other clinical staff to improve clinical outcomes for patients. However, there was a lack of local clinical audits, peer review and support to monitor and improve patient outcomes and experience. The high use of locum GPs caused anxiety and concern for patients. Care and treatment was not always considered in line with recognised best practice standards and guidelines and in line with current legislation.
• The practice was caring, staff treated patients with dignity and compassion.
• The service was responsive. The practice provided good care to its population taking into account their health and socio economic needs. Patients were listened to and feedback was acted upon. Complaints were managed appropriately.
• Whilst there was good open and transparent leadership form the practice manager, improvements were required in terms of clinical leadership and support available to staff. Systems to monitor, evaluate and improve services required improving. Staff enjoyed working for the practice and felt supported and valued.

There were areas of practice where the provider needs to make improvements.

Action the provider MUST take to improve:

• Ensure the practice has suitable arrangements in place for obtaining and acting in accordance with consent of patients in relation to their care and treatment. Some staff did not have sufficient knowledge of the Mental Health Act 2003, the Mental Capacity Act 2005 and the Children’s Act 1989.

Action the provider SHOULD take to improve:

• Ensure full and complete required information relating to workers is obtained and held when recruiting staff. This must include a Disclosure and Barring Service (DBS) check for all staff with chaperoning responsibilities or a risk assessment to support their decision not to undertake this.
• Ensure that full and comprehensive records are made when serious events and incident occur to encourage learning and improvement.
• Staff should undertake chaperone training and records should be made when this is carried out for patients
• Ensure doctors have available emergency drugs for use in a patient’s home or a risk assessment in place supporting their decision not to have this.
• Have available the use of equipment such as pulse oximeters, defibrillators and oxygen for emergency treatments or a risk assessment in place supporting
• Ensure staff have appropriate support from a practice safeguarding lead person.
• Ensure there is a systematic programme of clinical and internal audit and that action is taken when improvements are identified.
• Ensure that all clinical equipment is PAT tested annually.
• They should review the high use of locum GPs at the practice to ensure patients receive consistency and continuity of care when attending appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice