Letter from the Chief Inspector of General Practice
This practice is rated as requires improvement overall. The previous inspection, carried out on 1 March 2016 rated the practice as good overall, and requires improvement for providing well-led services.
The key questions are rated as:
Are services safe? – Requires improvement
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? – Requires improvement
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Requires Improvement
People with long-term conditions – Requires Improvement
Families, children and young people – Requires Improvement
Working age people (including those recently retired and students – Requires Improvement
People whose circumstances may make them vulnerable – Requires Improvement
People experiencing poor mental health (including people with dementia) – Requires Improvement.
We carried out an announced comprehensive inspection at Todmorden Group Practice on 6 December 2017. We carried out this inspection as part of our inspection programme, and to review improvements or changes made to the leadership of the practice since our last inspection.
At this inspection we found:
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The practice had systems in place to report incidents and near misses. Incidents were logged and discussed on a case by case basis. However learning from incidents was not always communicated effectively.
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Staff induction and training systems were in place. However we found that where staff had been externally supplied, assurances in relation to competency and medical indemnity cover were not established prior to employment.
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Staff were not clear about who had responsibility in lead areas for clinical governance issues. We were not assured that the leadership areas identified as requiring improvement in the inspection conducted on 1 March 2016 had been fully addressed.
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The practice had a number of policies and protocols in place in relation to staff activity. However the practice was unable to demonstrate oversight and review of these, as most were not dated and had no identified review date. Following receipt of the draft report the practice advised us that this had been rectified.
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Some staff told us they did not always feel supported by the senior leadership team.
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The practice participated in Calderdale Clinical Commissioning Group Commissioning Engagement Scheme in relation to assessing and monitoring the quality of services provided. However, we did not see evidence of completed, two cycle audits to address key areas of performance and improvement.
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There were externally developed policies, systems and processes to manage health and safety within the practice.
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The practice had infection prevention and control measures in place. However we identified shortfalls in relation to some checking and logging processes.
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Regular clinical and staff meetings were held, however we saw limited evidence that key governance areas such as significant events, complaints, patient and medicine safety alerts and other clinical updates were routinely discussed and reviewed.
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The practice had systems for dealing with complaints in line with national timescale requirements. Not all written communications with patients contained Parliamentary and Health Service Ombudsman details.
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The practice was piloting a same day access scheme to improve access to appointments.
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The practice had good facilities and a number of additional services were provided on site.
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We observed patients being treated with compassion and respect. The practice participated in the local ‘Altogether Better’ service, which made use of health champions to engage patients in a number of social inclusion activities to reduce isolation and enhance well-being.
The areas where the provider must make improvements as they are in breach of regulations are:
The areas where the provider should make improvements are:
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Review prescription security processes within the practice in line with the current guidance.
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Review and improve their communications with complainants to assure themselves that they are always advised of the options available to them if they are not happy with the outcome of their complaint.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice