The Care Quality Commission
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  • GP practice

Buckshaw Village Surgery

Overall: Good read more about inspection ratings

Buckshaw Village Health Centre, Unity Place, Buckshaw Village, Chorley, Lancashire, PR7 7HZ (01772) 376600

Provided and run by:
Dr Nimalendran Muttucumaru

All Inspections

26 July 2022

During a routine inspection

We carried out an announced inspection at Buckshaw Village Surgery on 25 and 26 July 2022. Overall, the practice is rated as Good.

For each key question we rated the following;

Safe - Good

Effective - Good

Caring - Good

Responsive - Good

Well-led - Good

Following our previous inspection on 9 December 2021, the practice was rated requires improvement overall, was rated inadequate for safe and requires improvement for effective, responsive and well-led key questions. Improvements had been implemented since then and at this inspection no breaches of regulations were found, therefore the rating moved to good overall.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Buckshaw Village 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 concerns and breaches of regulation identified during the previous inspection.

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 site visit
  • Requesting documents and information from the provider.
  • The completion of feedback forms by staff.

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

We found that:

  • The practice had addressed all the issues identified in the previous inspection. They had put in place systems and processes around safety and governance.
  • The clinical records reviews we conducted on this inspection showed an improvement and patients on high risk drugs and those with long term condition received the correct monitoring.
  • Recruitment checks were undertaken in line with regulations and appropriate evidence recorded and stored.
  • Infection prevention and control audits were in place with appropriate actions taken and evidenced as completed.
  • There were cleaning schedules in place and there was oversight of the cleaning contract. Environmental walkarounds were conducted and recorded.
  • The incident reporting process was improved to clarify the actions taken to ensure risk was reduced and learning was achieved.
  • Clinical supervision and quality monitoring was in place for clinical staff including non-medical prescribers and locum staff.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. While patient feedback in the national patient survey indicated ongoing dissatisfaction around access, we saw the practice had worked hard to implement measures to improve this, and we saw evidence 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.

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

  • Continue the improvement work leading from the DNACPR audit of records to ensure that where patients lack capacity the patients’ records have evidence of mental capacity assessments and best interests decisions.
  • Continue to work on the initiatives to improve patient satisfaction as identified from the NHS patient survey and continue to monitor satisfaction through surveys.
  • Continue the improvement initiatives from the use of clinical search audits to ensure monitoring of high risk medicines and long term conditions are managed well.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

09 December 2021

During a routine inspection

We carried out an announced inspection at Buckshaw Village Surgery on 6 and 9 December 2021. Overall, the practice is rated as requires improvement.

The key question ratings are as follows:

Safe - Inadequate

Effective – Requires Improvement

Caring - Good

Responsive – Requires Improvement

Well-led – Requires Improvement

Following our previous inspection on 6 December 2016, the practice was rated Good overall and for all key questions, except the responsive key question, which was rated Outstanding:

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

Why we carried out this inspection;

This inspection was a fully comprehensive inspection due to concerns that were raised to us about this provider.

How we carried out the inspection/review

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 and face to face
  • 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
  • Speaking with other professionals such as care home managers

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 Requires Improvement overall

We found that:

  • There were a significant number of issues relating to safety including gaps in relation to medicines management. For example, we found numerous patients that had not had appropriate monitoring for their medicines or conditions.
  • There were concerns with recruitment systems that were in place including where conduct of staff had not been checked from a previous employer, contracts unsigned and DBS checks missing. We found that risk management was not always effective. For example, infection control audits that were in place were not working as intended.
  • Systems to govern staffing were not working effectively and performance assurance systems were not working as intended. We saw that the practice had exceeded targets on childhood immunisations but had not yet reached cervical screening targets, given the pressure the sector had been under.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients felt that they could not always access care and treatment in a timely way. The practice had taken action to address this including self-funding a new telephony system; but as this was newly established, they were unable to demonstrate that it had yet been successful.
  • There was a disconnect between practice leaders’ expectations of day to day operations and the reality of these. We saw that oversight was lacking and silo working in and between teams, leading to gaps.

We saw an area of outstanding practice;

  • The provider had set up a Covid-19 Vaccine centre at jubilee House in Preston. They had created a new and separate staff team and had vaccinated 103,000 patients in the last 12 months. NHS Choices feedback for this centre was positive, with 110 comments praising the staff and the systems governing the centre.

We found breaches of regulations. The provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure specified information is available for each person employed.

The care quality commission are following its enforcement policy in dealing with the risks identified at this location.

The provider should:

  • Seek to determine if measures established to address low patient satisfaction were successful.

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

22 December 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Buckshaw Village Surgery on 22 December 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events although actions taken as a result of these events were not formally reviewed.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Risks to patients were assessed and well managed although the practice did not always have sight of risk assessments or checks done on their behalf by the building management company.
  • 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.
  • The practice maintained high standards of infection prevention and control and audited these standards regularly. Actions were taken to address any improvements indicated although these actions were not always documented.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • 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.
  • There were good governance arrangements in relation to having an overview of staff training, medical indemnity and membership of professional bodies although this overview was occasionally lacking in relation to locum GPs’ safeguarding training.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice:

  • The practice organised clinical education events on a Saturday every two months for GPs in the local area. Training was delivered by invited clinicians and was free of charge for attendees. On average, 27 clinicians attended each event. We saw examples of positive feedback for these events and evidence of improvements to local procedures and better communication between clinicians as a result.
  • The practice worked closely with a local retirement community of 236 apartments which was based in premises which the practice had partly occupied for two years from 2009 to 2011. The practice kept one of the rooms that it had previously occupied and ran two clinics a week from there for these patients and also provided “ward rounds” for patients unable to come to the clinics. Feedback from the community praised the surgery for its patient-centred approach to care and the positive effect that the service had had for those residents.
  • In 2012 and 2013, the practice had developed the use of a computer tablet that gave clinicians mobile access to the patient computer record system. This tablet could be used during patient home visits and when away from the surgery premises. The practice subsequently shared this initiative with the clinical commissioning group who recognised the benefits of this, piloted the system in 2014 and then supplied 120 tablets to 64 other local practices for this purpose in 2015.
  • The practice offered a daily point of care service for blood monitoring for patients who were taking blood-thinning medications for heart conditions. This service used new technology attached to the practice mobile tablet and in house computer system so that patients could be monitored, assessed and issued with an appropriate prescription all at the one appointment or home visit. This avoided delays in the issuing of prescriptions to patients and reduced the administration associated with the monitoring process.
  • The practice worked with a local care home service for patients who were experiencing the effects of neurological damage or conditions. They visited the service twice a week and provided care for residents and support and training for staff at the home. The practice told us that inappropriate admissions to hospital for these patients had been reduced over the time of their involvement and recent audit showed that over 95% of admissions for these patients were appropriate. Feedback from the service manager confirmed that the surgery intervention had been instrumental in this and detailed improvements in wellbeing for residents.

The areas where the provider should make improvement are:

  • Put systems in place to review actions taken as a result of significant events to ensure that they were effective.
  • Maintain an oversight of premises risk assessments and checks carried out by the building management company.
  • Improve the documentation of actions taken to address concerns identified by infection prevention and control audits.
  • Carry out the same oversight of safeguarding training for locum GPs as for GPs in the practice.
  • The practice should continue to improve the identification of patients who are also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

15 August 2013

During a routine inspection

Buckshaw Village Practice is situated in the newly developing Buckshaw Village complex on the outskirts of Chorley. Whilst we were at the practice we observed staff interacting positively with patients. During our visit we spoke with five patients and they all provided us with very positive feedback. Care was described by all the patients we spoke with as being of a high standard. Due to technical issues the date in the 'how we carried out this inspection' is incorrect. We conducted this inspection on the 12 June 2013.

Patients we spoke with told us they felt safe receiving care and support from the staff at the practice. The patients we spoke with all told us they were more than happy with the level of cleanliness. Their comments included, "It's a new building you'd expect it to be" and "It's brand new for a kick off so that helps". There were adequate disabled facilities and all treatment/consulting rooms were on the same level. All rooms were lockable and there was appropriate screening to maintain a patient's dignity and privacy whilst being treated. All the patients we spoke with all told us they had never had any cause to complain but felt that staff would listen to them and deal with any concerns appropriately. When we spoke with one of the GPs they told us, "I think we have an excellent team who are competent and qualified. All have good communication skills and I feel patients are being listening to. We have a good IT system which is used to its full potential."