The Rose Tree PMS Practice Also known as White Rose Medical Practice

We carried out an announced comprehensive inspection at The Rose Tree PMS Practice on 5 February 2019 and the practice was rated as inadequate and placed into special measures.

At this inspection we followed up a practice in special measures and on breaches of regulations identified at the previous inspection in February 2019.

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

At the last inspection we rated the practice as inadequate for providing safe and well-led services because:

• The practice did not have clear systems and processes to keep people safe and the overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks to improve the quality and safety of the services being provided.

At the last inspection we rated the practice as requires improvement for providing effective, caring and responsive services because:

• Some performance data was significantly below local and national averages and the provider was unable to show that staff had the necessary skills, knowledge and experience to carry out their roles.
• The provider had not undertaken any patient surveys to review and improve patient satisfaction following the national patient survey.

We have rated this practice as requires improvement overall.

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

• The provider had not risk assessed the safeguarding training requirement for administrative staff. GPs and non-clinical staff had not undertaken infection prevention and control training.
• The provider did not have oversight of health and safety and fire risk assessments at the branch site.

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

• Staff had taken action to improve outcomes for cervical screening and for those with poor mental health.
• Staff had access to online learning and a programme of staff training had commenced.

We rated the practice as  good  for providing caring services because:

• The provider was working with the patient participation group to survey patient experience.  The national GP patient survey results had improved with regard to being involved in decisions about care and treatment.

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

• At this inspection we found that apart from telephone access most National GP survey results had improved. The practice was working with other practices in the building to review telephone access with the landlord.

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

• The provider had developed an action plan to address the shortfalls from the previous inspection. We saw that this was in progress and actions underway. However, some actions had yet to be completed.
• The provider had addressed the immediate actions required for the practice to improve but this had not been captured into a practice development plan.
• The practice did not have a Freedom to Speak up Guardian and staff were yet to undertake equality and diversity training.
• The provider did not have oversight of the fire and health and safety risk assessments at the branch premises.

The areas where the provider must make improvements are:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

I am taking this service out of special measures. This recognises the improvements made to the quality of care provided by this service. We will follow up the requires improvement domains during an inspection at a later date

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 Rose Tree PMS Practice on 5 February 2019 as part of our inspection programme. Our last inspection of the Rose Tree PMS Practice was in December 2014 and the practice was rated as Good.

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:

• The practice did not have clear systems and processes to keep patients safe. Not all staff had received the appropriate level of safeguarding training.
• The recruitment policy had not been fully implemented and not all the required checks had been undertaken.
• Health and safety checks had not been completed for all areas within the practice remit and staff had not had all the required training in health and safety matters such as fire safety and infection prevention and control.
• Provision of emergency medicines was not based on risk assessment. Not all staff were aware of the emergency equipment and medicines provided and how to access these or training in basic life support.

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

• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.
• Some performance data was significantly below local and national averages.

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

• Data showed low patient satisfaction with the service in some areas, although on the day of the inspection we found good levels of patient satisfaction. However, the practice had not undertaken any patient surveys to review and improve patient satisfaction following the national GP survey.

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

• Data showed low patient satisfaction with the service in some areas although on the day of the inspection we found good levels of patient satisfaction. However, the practice had not undertaken any patient surveys to review and improve patient satisfaction following  the national GP survey.

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

• While the practice had a clear vision, and a credible strategy staff had not always been involved.
• The overall governance arrangements were not always effective. Policies and procedures were not always accessible to staff.
• The practice did not have clear and effective processes for managing risks and to improve the quality and safety of the services being provided.

These areas affected all population groups so we rated all population groups as requires improvement.

The areas where the provider must make improvements are:

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

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed. Ensure specified information is available regarding each person employed. Ensure, where appropriate, persons employed are registered with the relevant professional body.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

The areas where the provider should make improvements are:

• Review and establish tenant responsibilities, if any, in regard to the health and safety risk assessments undertaken by the landlords of each site.
• Consider the use of a clinical tool to identify older patients who are living with moderate or severe frailty.
• Review and improve how information about the practice is shared with the patient participation group.

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.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care