Dr Pilkington and Partners Also known as Cruddas Park Surgery

We carried out an announced focused inspection at Drs Turner Antoun and Partners on 26 March 2019. This was as part of our ongoing inspection programme and to check the practice had made the improvements we said they should when we last inspected the practice in April 2018.

At the last inspection on 20 April 2018 we rated the practice as requires improvement for providing safe services because:

• The practice did not always follow up on actions identified through their own audits and risk assessments to keep people safe.
• They did not always carry out full checks during the recruitment process to check the conduct of staff during previous employment.
• They did not keep clear records to demonstrate the action they had taken in response to patient and medicine safety alerts.

At this inspection, we found that the provider had satisfactorily addressed these areas.

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 rated this practice as good overall. (Previous rating April 2018 – Good). We rated the practice as good for providing safe services because:

• The practice had improved the way they followed up risks identified through their own audits and risks assessments.
• Improved the way they checked conduct of staff in previous employment.
• Kept clear records of the action they had taken in response to patient and medicines safety alerts.

At our previous inspection in April 2018, there were other areas where we told the practice they should improve. During this inspection, the practice demonstrated they had addressed the concerns. This included:

• Improving the approach to clinical audit and quality improvement. The practice had implemented a clinical audit strategy for the financial year, which included planned audits for prescribing of antipsychotics for patients diagnosed with dementia; two-week wait referrals for patients with symptoms of suspected cancer; and prescribing of pregabalin. There were also other medicine audits planned by the pharmacy hub within the practice. The practice provided us with a completed (two-cycle) audit of women of childbearing age prescribed sodium valproate and the first cycle audit for the audit of prescribing of antipsychotics for patients diagnosed with dementia.
• Increasing the identification of patients who were also carers and developing the support for carers. In March 2019, we found the practice had increased the number of carers identified from 0.7% (72 carers) of the patient list to 1.27% (131 carers). They had achieved this by publicising information for carers within the practice; holding carer awareness events; and, using opportunities. such as influenza vaccination clinics, to flag up where patients had caring responsibilities. The practice told us they continued to liaise with the local carers organisation to help them identify and meet the needs of carers. They also offered influenza vaccinations to all carers.
• Improving the approach to meeting the Accessible Information Standards to help tailor their communication methods to meet the needs of all those patients who might benefit from this. In March 2019, we found the practice had implemented a register of patients with additional communication needs. They had also implemented changes to the new registration process to capture communication needs at an early stage. They had put in place arrangements to meet the communication needs of patients in line with the Accessible Information Standards.
• In March 2019, we found the practice now directed patients to contact the public health services ombudsman if they remained unsatisfied with the outcome of their complaint.

In March 2019, we also found the practice had tried to improve the arrangements for the patient participation group, to increase membership. They continued to promote the group, both in the practice waiting area and on their website. They had encouraged new members to join during an event to celebrate the birthday of the NHS and during the influenza vaccination clinics. However, these initiatives had not supported the practice to recruit any new members. They told us they used other sources of patient feedback, such as surveys, the NHS friends and family tests, complaints and compliments to inform service improvements.

The area where the provider should make improvements is:

• Continue to develop the approach to recording of staff immunity level for measles, mumps, chickenpox and rubella in line with The Green Book Immunisation against infectious disease where staff are uncertain or do not hold information about their level of immunity.

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