Archived: St Thomas Road Surgery

We carried out an announced inspection at St Thomas Road on 6 February 2020 and 13 February 2020 following our annual review of information available to us. This was a comprehensive inspection which looked at all key questions.

The previous inspection took place in December 2018 and the report can be found on our website at . The practice was previously rated as good overall.

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 Inadequate overall.

We rated the practice as Inadequate for providing safe services because:

• Systems, process and practices were not reliable at keeping people safe and were not monitored.
• Staff did not have the information they needed to deliver safe care and treatment.
• Risks were not always identified and acted on to prevent patients from harm.
• There was a lack of clinical oversight for prescribers within the practice

We rated the practice as Inadequate for providing effective services because:

• Staff did not receive adequate supervision or support to enable them to deliver good quality care.
• There was limited monitoring of people’s outcomes of care and treatment.
• Childhood immunisations and cancer screening performance were below average with limited evidence of any work completed by the practice to improve it.

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

• the low satisfaction of patient feedback in regard to care received at the practice.

We rated the practice as Inadequate for providing responsive services because:

• There was limited evidence of complaints driving continuing improvement within the practice
• There were occasions where appointments were cancelled by the practice at short notice due to a lack of clinicians.
• There was no evidence to suggest services were planned in conjunction with other local services as the practice did not hold multidisciplinary team meetings for patients with additional needs.

We rated the practice as Inadequate for providing well-led services because:

• The delivery of high-quality care was not assured by the leadership, governance or culture in place
• There was a lack of systems for identifying, capturing and managing issues and risks.
• There was minimal engagement with people who use the services and staff.
• There was little innovation and evidence of continuous improvement

These areas affected all population groups so we rated all population groups as Inadequate.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Engage with the local population to improve uptake of immunisation and cancer screening.
• Monitor and improve patient satisfaction in relation to treatment received at the practice.
• Improve the uptake of annual reviews for patients with learning disabilities.

(Please see the specific details on action required at the end of this report).

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

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

This practice is rated as Good overall. (Previous rating November 2017 – Requires improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at St Thomas Road Surgery on 4 December 2018. This inspection was planned and undertaken as part of our inspection programme and as part of a wider inspection of the provider (One Medicare Ltd). The provider had agreed to contribute to our Primary Care at Scale project.

At this inspection we found:

• Effective systems were in place to promote adult and child safeguarding.
• Safety checks of equipment and the premises were taking place.
• The premises were clean and infection control guidance was being followed.
• Medicines were safely managed.
• There was a backlog of medical records that required summarising.
• The practice team reviewed significant events to learn and share best practice.
• The practice ensured that care and treatment was delivered according to evidence-based guidelines.
• The practice had systems in place to improve performance in the Quality and Outcomes Framework (QOF). QOF Performance in the area of diabetes, cancer screening and childhood immunisation rates continued to be a challenge for the practice.
• The practice was rated below both the local Clinical Commissioning Group (CCG) and national averages in the GP Patient Survey. However, patients were observed to be treated with kindness and recent practice surveys showed positive patient feedback. Patients spoken to and comments cards received were generally positive regarding the practice.
• Feedback regarding access to appointments was mixed. The practice was aware of this and were working to improve access.
• Complaints were mostly managed appropriately, however, improvements could be made.
• We found a supportive culture within the practice.
• The practice had a vision and values in place and staff were observed to act in line with them.
• Governance arrangements were in place.
• Patient feedback mechanisms were in place and were continuing to be developed.

There were some areas where the provider should make improvements:

• The practice should put measures in place to ensure that all patient records are summarised in a timely manner to support safe and effective care.
• The practice should continue to work to improve QOF performance in the area of diabetes and to improve cancer screening and childhood immunisation rates.
• The practice should continue to identify patients who are caring for others, so that their needs can be assessed and support provided accordingly.
• The practice should review and improve the information provided to complainants on who to escalate complaints to in the event of remaining dissatisfied, to accurately reflect the provider’s policy in all cases.
• The practice should continue to develop the information available for patients whose first language is not English. This should include patient feedback mechanisms.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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