The Limes Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Summerfield & Partners on 8 August 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the August 2017 inspection can be found by selecting the ‘all reports’ link for Dr Summerfield & Partners on our website at www.cqc.org.uk.

After the inspection in August 2017 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

This inspection was an announced focussed inspection carried out on 27 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 8 August 2017. This report covers findings in relation to those requirements.

The inspection carried out on 27 March 2018 found that the practice had responded fully to the concerns raised at the August 2017 inspection. The overall rating for the practice is now good.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services responsive? – Good

Are services well-led? – Good

As part of our inspection process we also look at the quality of care for specific patient population groups. The patient population groups are rated as:

Older people – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) – Good

Our key findings were as follows:

• The practice had made further improvements to the system that managed significant events.
• Staff were up to date with essential training.
• Further improvements had taken place to the assessment and management of risks to patients, staff and visitors.
• The practice had identified 212 patients on the practice list who were carers (1.3% of the practice list and 16 more than at the time of our last inspection in August 2017).
• Appointment availability had increased since our last inspection in August 2017.
• Additional staff had been recruited and there were plans to work together with two other local practices to offer additional extended hours appointments.
• Governance arrangements had improved and the practice was now keeping records of action taken (or if no action was necessary) in response to the receipt of all notifiable safety incidents.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Summerfield & Partners on 17 November 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Dr Summerfield & Partners on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 8 August 2017. Overall the practice is now rated as requires improvement.

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

• There was a system for reporting, recording and investigating significant events.
• The practice had made improvements to the systems, processes and practices that helped to keep patients safe and safeguarded from abuse. However, further improvements were still required.
• There had been improvements in arrangements to deal with emergencies and major incidents.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Data from the Quality and Outcomes Framework (QOF) demonstrated that the practice was performing in line with local and national averages for patient outcomes.
• There was evidence of clinical audits driving quality improvement.
• The practice had developed and introduced an induction programme for all newly appointed staff.
• Records showed that staff who had worked at the practice for more than 12 months had received appraisals and GPs had revalidated or had a planned revalidation date.
• Not all staff were up to date with essential training. However, the practice was in the process of addressing the training needs of staff.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was lower than local and national averages. However, where national GP patient survey results were below average the practice had developed and implemented an action plan to address the findings and improve patient satisfaction.
• Some of the patients we spoke with said they were not always able to book a routine appointment that suited their needs. Some patients said they were not able to get an emergency appointment and attended the local accident and emergency department or telephoned the out of hours service instead.
• The practice had made improvements to the system for handling complaints and concerns.
• Improvements to governance arrangements at the practice had taken place. However, further improvements to risk assessment and management were found to be required.
• The practice was now sending statutory notifications and registration applications to the Care Quality Commission (CQC) in a timely manner.
• There was a clear leadership structure and staff felt supported by management. The practice gathered feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had systems for notifiable safety incidents. However, they did not always keep records of action taken (or if no action was necessary) in response to receipt of all notifiable safety incidents.

The areas where the provider must make improvements are;

• 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 persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvements are;

• Share learning from significant events with locum staff.

• Continue to identify patients who are also carers to help ensure they are offered appropriate support.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice