Archived: Branston Surgery Also known as The Surgery

In November 2022, the practice was rated as inadequate overall and for the key questions of safe and well-led and as requires improvement for the key questions of effective. The practice was placed into special measures.

We carried out an announced focussed inspection at Branston Surgery 10 January 2023 to review compliance with Warning Notices which were issued following our previous inspection on 8 November 2022 which had to be met by 9 January 2023, but the inspection was not rated.

The ratings from November 2022 therefore still apply and will be reviewed via a further inspection to take place within the next six months.

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

The ratings for each key question are;

Safe - Inadequate

Effective – Requires Improvement

Well-led – Inadequate

Why we carried out this inspection

This inspection was a review of information to follow up on the Warning Notices we served for breaches of Regulation 12, Safe Care and Treatment, Regulation 13, Safeguarding Service Users from Abuse and Improper Treatment and Regulation 17, Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2104.

How we carried out the inspection/review

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Completing clinical searches on the practice’s patient records system.
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.
• Discussions with staff.

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 have not rated this practice as the rating remains unchanged until we have completed a further inspection incorporating all relevant key questions.

We found that:

Actions had been taken to address most of the areas of the breaches identified in the warning notices and it was evident improvements had been made. However, some required actions were not yet fully completed or embedded.

However, we found that:

Actions had been taken to meet the breaches identified in the warning notices. However, some required actions were not yet commenced, fully completed or embedded.

We found that:

• The practice had systems for the appropriate and safe use of medicines in relation to high risk medicines.
• The practice was able to show management of patient safety alerts was now effective.
• The practice were able to show that patient’s treatment was regularly reviewed in line with current evidence based practice.
• The practice had a comprehensive programme of quality and improvement activity.
• Leaders were now able to demonstrate they understood challenges to quality and sustainability and had identified actions to address.
• The practice had implemented a set of vision and values to support the delivery of quality of care.
• Improved uses of data and information was being utilised to support decision making.
• Systems and processes for learning, continuous improvement and innovation had been introduced or were planned.
• Systems and processes had been introduced which had improved safeguarding service users from abuse. However, further improvements and embedding within the practice were required.
• The practice had improved the management of risks to patients. However, compliance of staff trained to manage medical emergencies required further improvement.
• Further planned improvements in relation learning from and dissemination of information from safety concerns needed to be implemented.
• Improvements had been made to effective care delivery and the management of patients with long term conditions. However, systems and processes needed to be applied across all healthcare pathways.
• Further work was required to ensure there was dedicated protected time for meetings, improved communication, staff training and development to improve care and culture within the practice.
• The overall governance arrangement had improved. However, improvements and process for governance and managing risks, issues and performance need further work.

The provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure patients are protected from abuse and improper treatment.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We have issued the provider with Requirement Notices for breaches of:

Regulation 12 (1), Regulation 13 (2) and Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 Hospitals and Interim Chief Inspector of Primary Medical Services