6 February 2018
During a routine inspection
Dr David Laurence Dawes (the provider) had been inspected previously at The Surgery Ashby on the following dates:
-
29 June 2017 under the comprehensive inspection programme. The practice was rated Inadequate overall and placed in special measures for a period of six months. Breaches of legal requirements were found in relation to safeguarding service users from abuse and improper treatment and governance arrangements within the practice. Warning notices were issued which required them to achieve compliance with the regulations set out in the warning notices by 20 October 2017.
-
6 December 2017 - A focused inspection was undertaken to check that they now met the legal requirements. Regulation 13, safeguarding service users from abuse and improper treatment had been met in full. However not all the requirements of the warning notice had been met in relation to Regulation 17 Good Governance. A requirement notice were issued and an action plan was sent, in which the practice identified what improvements would be put in place to ensure compliance of the regulation.
Reports from our previous inspections can be found by selecting the ‘all reports’ link for The Surgery Ashby on our website at www.cqc.org.uk.
This inspection was undertaken following a six month period of special measures and was an announced comprehensive inspection on 6 February 2018.
This practice is rated as Inadequate overall. (Previous inspection in June 2017 was inadequate).
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Inadequate
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Inadequate
As part of our inspection process, we also look at the quality of care for specific population groups.
The population groups are rated as:
Older People – Inadequate
People with long-term conditions – Requires Improvement
Families, children and young people – Requires Improvement
Working age people (including those retired and students – Requires Improvement
People whose circumstances may make them vulnerable – Inadequate
People experiencing poor mental health (including people with dementia) - Inadequate
At this inspection we found:
-
We found an improved system in place for reporting and recording significant events, lessons were shared to make sure action was taken to improve safety in the practice.
-
The practice had an effective system in place to safeguard children and vulnerable adults from abuse.
-
Patients’ health was not always monitored in a timely manner to ensure medicines were being used safely and followed up on appropriately.
-
The practice did not routinely review the effectiveness and appropriateness of the care it provided. Care and treatment was not always delivered according to evidence- based guidelines. We found very limited evidence of care plans in place to ensure vulnerable older people, high risk patients and patients needing end-of-life care received care and treatment that is appropriate to their needs.
-
There was limited quality improvement.
-
Staff had not received an appraisal in the last 12 months.
-
The most recent results from the national GP patient survey published in July 2017 was consistently high and showed extremely positive patient satisfaction in all of the 23 outcomes. The practice had been ranked top in Leicestershire.
- Feedback from people who use the service was consistently and strongly positive. 29 patients expressed high levels of satisfaction about all aspects of the care and treatment they received. The feedback from comments cards we reviewed told us that staff worked hard, had a caring attitude and were concerned about their patient’s wellbeing. The service provided was friendly, efficient, staff listened and gave you complete confidence.
-
The practice had made improvements to their governance arrangements and had taken some of the appropriate steps required to ensure patients remained safe. Further work was still required in regard to quality improvement to improve patient outcomes, management of risk and meeting minutes.
- At this inspection we still had concerns in regard to the clinical oversight and governance arrangements in place.
The areas where the provider must make improvements as they are in breach of regulations 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
This service was placed in special measures on 17 August 2017. Insufficient improvements have been made such that there remains a rating of inadequate for this inspection.
At present we are not taking further action in line with our enforcement procedures as the practice have begun the process to merge with another local GP practice. They will remain in special measures.
The practice have been sent a letter in which we have set out all the concerns found at the inspection and the Commission require them to send us fortnightly action plans in respect of the areas of concern found at the inspection on 6 February 2018.
The service will also be kept under review and if needed further action could be taken in line with our enforcement procedures to begin the process of preventing the provider from operating the service which would lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This could be escalated to urgent enforcement action.
Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice