Archived: The New Surgery

We carried out an announced comprehensive inspection at The New Surgery on 20 March 2019. Overall the practice was rated as good. However, we identified breaches of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided safe services. Consequently, the practice was rated as requires improvement for providing safe services.

At the inspection on 20 March 2019, the provider was informed they must:

• Ensure care and treatment is provided in a safe way to patients.

Additionally, the provider was informed they should:

• Adhere to the intercollegiate guidance on safeguarding competencies so that staff complete the appropriate level of safeguarding training for their roles.
• Consider the use of a data logger in the vaccine fridge.
• Continue to maintain an 80% attainment for women adequately screened for cervical cancer.
• Consider using a palliative care template to ensure consistent reporting of appropriate data sets for these patients.

The full comprehensive report on the March 2019 inspection can be found by selecting the ‘all reports’ link for The New Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 December 2019 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches of regulation that we identified in our previous inspection on 20 March 2019. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

On this focused inspection we found that the practice had made improvements since our previous inspection and were now meeting the regulation that had previously been breached.

The practice is now rated as good overall and good for providing safe services.

We found that:

• The practice had clear systems and processes to keep people safe. Staff completed safeguarding training at the appropriate level for their roles. Staff vaccination was maintained in line with Public Health England (PHE) guidance and appropriate records were available to demonstrate this.
• Staff had the information they needed to deliver safe care and treatment. There was a comprehensive process in place to code, monitor, and respond to instances of ‘was not brought’ children. The process was well documented and adhered to. Pre-diabetic patients were appropriately identified and coded. Patients who chose to participate were referred to the national diabetes prevention programme.
• The practice had systems for the appropriate and safe use of medicines. Blank prescription forms were securely stored and monitored at all times. A process was in place and adhered to for all nurses to sign their review and understanding of Patient Group Directions (PGDs). Data loggers were used to effectively monitor and record fridge temperatures and alert staff to any discrepancies. A process was in place and adhered to for recording the completion of patients’ medicine reviews. At the time of our inspection, 83% of reviews had been completed. Information about medicines prescribed to patients on a repeat basis in secondary care (hospital) were available to and accessed by GPs at the practice. The GPs had sight of secondary care monitoring results for patients prescribed high-risk medicines. They used this information to complete the appropriate clinical review of these patients before prescribing their medicines.
• The system for recording and acting on safety alerts was sufficient. Medicines and Healthcare products Regulatory Agency (MHRA) alerts were appropriately received, reviewed and discussed at the practice. Action was taken in response to the alerts received and this was well documented.
• During our March 2019 inspection, Public Health England (PHE) data for the year April 2017 to March 2018 showed the percentage of women at the practice eligible for cervical screening at a given point in time and who were screened adequately within a specified period was 75.5%. This did not meet the 80% national programme standard. We found a comprehensive process was in place at the practice to encourage women to attend for their cervical screening test. The practice’s own unverified data showed 80% of eligible patients had attended for a cervical screening test. During this inspection, the practice’s own unverified data for December 2019 showed they had continued to meet the national programme standard and 80% of eligible patients aged between 25 and 49 years, and 83% of eligible patients aged between 50 and 64 years were adequately screened within a specified period.
• At our last inspection we found that end of life care was delivered in a coordinated way. These patients’ needs were routinely clinically discussed, and their care plans were well maintained, reviewed, and updated. GPs at the practice didn’t use a palliative care template to ensure consistent reporting of appropriate data sets for these patients. During this inspection, we saw the practice had developed and implemented its own palliative care template. These were reviewed and updated for each relevant patient at well attended multi-disciplinary team meetings. The examples we looked at were well completed and demonstrated a structured and consistent approach in the clinical management of these patients.

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

We carried out an announced comprehensive inspection at The New Surgery on 20 March 2019 as part of our inspection programme.

We based our judgement of the quality of care provided at this service on a combination of:

• What we found when we inspected;
• Information from our ongoing monitoring of data about services;
• Information from the provider, patients, the public and other organisations.

We rated the practice as good overall and good for all population groups.

We rated the practice as requires improvement for providing safe services because:

• The practice’s systems and processes to keep people safe were not always comprehensive.
• Staff did not always have the information they needed to deliver safe care and treatment.
• The practice’s systems for the appropriate and safe use of medicines, including medicines optimisation were insufficient.
• The practice did not have an appropriate system in place for recording and acting on safety alerts.

Please see the final section of this report for specific details of our concerns.

We rated the practice as good for providing effective, caring, responsive and well-led services because:

• Patients received effective care and treatment that met their needs. The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Staff involved patients in their care and treatment decisions and treated them with kindness, dignity and respect.
• The practice organised and delivered services to meet patients’ needs. 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-centred care and an inclusive, supportive environment for staff. There was a focus on continuous learning and improvement at all levels of the organisation. Where we identified any concerns during our inspection, the practice took action to respond or plans of action were developed to ensure any issues were resolved.

The area where the provider must make improvements is:

• Ensure care and treatment is provided in a safe way to patients.

Please see the final section of this report for specific details of the action we require the provider to take.

The areas where the provider should make improvements are:

• Adhere to the intercollegiate guidance on safeguarding competencies so that staff complete the appropriate level of safeguarding training for their roles.
• Consider the use of a data logger in the vaccine fridge.
• Continue to maintain an 80% attainment for women adequately screened for cervical cancer.
• Consider using a palliative care template to ensure consistent reporting of appropriate data sets for these patients.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and the evidence tables for further information.