The Care Quality Commission
  • Doctor
  • GP practice

The Pines Surgery

Overall: Requires improvement read more about inspection ratings

Harborough Road North, Kingsthorpe, Northampton, Northamptonshire, NN2 8LL (01604) 845144

Provided and run by:
The Pines Surgery

All Inspections

11 January 2024

During an inspection looking at part of the service

We carried out an announced focused inspection at The Pines Surgery on 11 January 2024. Overall, the practice is rated as requires improvement.

Safe - requires improvement

Effective - good

Caring - not inspected, rating of good carried forward from previous inspection.

Responsive – requires improvement

Well-led – good

Following our previous inspection on 21 July 2016, the practice was rated good overall and for all key questions.

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

Why we carried out this inspection

We carried out this inspection in line with our inspection priorities.

How we carried out the inspection/review

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visit.

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 found that:

  • Remote reviews of the clinical record system showed some patients who were prescribed medicines that required monitoring were overdue a review and relevant safety alerts had not always been responded to.
  • The uptake for cervical screening was below the 80% target set by the UK Health Security Agency.
  • The practice had taken some actions to improve telephone access and appointment booking and had plans to change their telephony system. However, it was too soon to assess the impact of these measures.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
  • The practice used significant events and complaints to identify areas of learning and improvement.

We found a breach of regulations. The provider must:

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

The areas where the provider should make improvements are:

  • Continue to take measures to improve the uptake of cervical screening.
  • Continue to take actions to improve patient satisfaction in relation to access and appointment booking.

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 Health Care

21 July 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Pines Surgery on 21 July 2016. Overall the practice is rated as good.

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • 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.
  • 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 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.

The areas where the provider should make improvement are:

  • Introduce a formal process to review and monitor infection control practices including regular training updates for all staff.

  • Complete alteration work commissioned to make the appointment desk equality act 2010 compliant.

  • Consider introducing a structure to clinical audit reports so the methodology findings and improvements are clear.

  • Continue to identify and support additional carers.

  • Continue to monitor patient survey results and ensure improvement to access to the practice over the phone.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice