Sabden & Whalley Medical Group

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sabden and Whalley Medical Group on 26 September 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice nurse had developed a range of interventions to help patients manage their diabetes and for patients at risk of developing diabetes. This included a regular patient education session for those whose blood sugar levels suggested they were pre-diabetic.
• Many risks to patients were assessed and well managed, though the storage and use of liquid nitrogen within the practice had not been risk assessed. The practice obtained control of substances hazardous to health (COSHH) information for cleaning products during the inspection and water sample testing was in place to test for legionella although a risk assessment to determine the level of the control regime required had not been undertaken.
• 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.
• Feedback from patients about their care was consistently positive.
• The practice had worked with the CCG and community providers to ensure health visitors, district nurses and community services were available to patients at the practice due to the rural location.
• The practice had good facilities and was well equipped to treat patients and meet their needs. This included a small minor surgery room and the practice also acted as a treatment room for the local area to offer urgent care to patients to save them travelling into the local hospitals and urgent care centres.
• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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 two areas of outstanding practice:

The practice nurse who specialised in diabetes care actively screened for pre-diabetes and developed interventions to help patients at risk of developing diabetes reduce their risk. Patients were encouraged to attend education sessions which reviewed lifestyle choices and gave patients ways to reduce their blood sugar levels and risk of diabetes. Of 141 patients screened during a twelve month period, 106 (76%) had their risk significantly reduced. In additional to this, the nurse had adapted CCG diabetes record card to include insulin monitoring and management information. This booklet had been rolled out by the clinical commissioning group (CCG) to other local practices.

The treatment room service was open to registered and non-registered patients throughout the working day and data shared by the practice demonstrated that over 550 patients had used the service in the previous 12 months.

However there were areas of practice where the provider must make improvements:

• Liquid nitrogen storage and use must be risk assessed and clear operating protocols should be in place to cover: filling containers, hazard signage, safe disposal, use of personal protective equipment and action to take in event of an emergency or spillage.

The areas where the practice should make improvements are:

• Undertake a legionella risk assessment to determine the correct level of legionella control regime required.
• Review the use of chaperones, the local policy and national guidance to determine whether current procedures are in line with best practice.
• There should be an auditable record of cleaning and management checks of the premises.
• Review the use of clinical audit to include full audit cycles and demonstrate continuous quality improvement in patient outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice