The Care Quality Commission
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Archived: Stuart House Surgery

Overall: Good read more about inspection ratings

Sleaford Road, Boston, Lincolnshire, PE21 8EG (01205) 362173

Provided and run by:
Stuart House Surgery

Important: The provider of this service changed. See new profile

All Inspections

6 April 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stuart House Surgery on 6 April 2016. Overall the practice is rated as good.

We had previously inspected this practice on 17 August 2015. On that occasion breaches of

legal requirements were found. After the inspection the practice wrote to us to say what they

would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

  • Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Safe Care and treatment

  • Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.

  • Regulation 18 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Staffing.

  • Regulation 19 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Fit and proper persons employed.

We found at this inspection of 6 April that improvements had been made since the previous inspection of August 2015 when the practice had been rated as ‘Requires Improvement’.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • 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 there was continuity of care, with urgent consultations 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.

We saw one area of outstanding practice:

  • The practice had a total of 135 patients who lived in one of 12 nursing of residential homes in Boston and surrounding villages. We saw that the high incidence of requests for home visits to these patients placed a considerable strain upon the service and we looked at records that showed that ten to 15 home visits to this category of patient was a common daily occurrence. On one particular day in the previous week eight of the nine home visits had been to these patients. The practice had responded to this demand on services and resources by employing a full time community based nurse practitionerto help meet the need of this patient group and to manage patients with long term conditions in their own homes.

The areas where the provider should make improvement are:

  • Ensure that there is a system in place to undertake interim audits and checks of infection prevention and control in-between annual audits.

  • Ensure that all meetings with other healthcare professionals, for example Health Visitors are routinely documented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

17 August 2015

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 16 and 21 October 2014. Breaches of legal requirements were found. After the comprehensive inspection the practice wrote to us to say what they would do to meet the legal requirements in relation to care and welfare of people who use the services, requirements which related to workers, records and assessing and monitoring the quality of the service provided. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for GP practices on our website at www.cqc.org.uk

We carried out a focussed inspection on 17 August 2015 to check that the practice had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. The practice has been rated inadequate for Safe and requires improvement for Effective and Well-led services. It was also requires improvement in providing services for all the population groups.

Our key findings across the areas we inspected were as follows:

  • There was a system in place for identifying, reporting on and learning from significant events. However the quality of the recording of the significant events was not satisfactory and did not demonstrate the steps taken by the practice to safeguard patients and prevent a reoccurrence.
  • Since the last inspection the practice had carried out an infection control audit however they had not completed an action plan to address the areas identified. Minutes of practice meetings showed that the findings of the audits had not been discussed.
  • Audits which the action plan showed would be carried out had not been completed since the last inspection therefore we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice had a system in place to manage and learn from complaints.
  • The practice had not proactively sought feedback from staff or patients since 2013.

The areas where the provider must make improvements are:

  • Ensure there is a robust system to manage and learn from significant events
  • Ensure an action plan and actions identified in the Infection Control audit are completed.
  • Have a robust system in place for the recruitment of staff.
  • Ensure that staff have appropriate support, identified through a formal appraisal system to enable them to deliver the care and work they carry out in the practice.
  • Ensure suitable arrangements are in place to assess, monitor and improve the quality of the services for provided, in particular, undertake completed clinical audits to demonstrate improvements in patient care.

In addition the provider should:

  • Ensure there are mechanisms in place to seek feedback from staff and patients.
  • Regular checks to ensure that the upstairs filing room door remains locked at all times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

16 and 21 October 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

Stuart House Surgery is located in the town of Boston, Lincolnshire and provides primary medical services to approximately 8,382 patients.

We carried out a comprehensive inspection on 16 and 21 October 2014. We spoke with patients and staff including the management team. The inspection focussed on whether the care and treatment of patients was safe, effective, caring, responsive and well led.

The overall rating for Stuart House Surgery is ‘requires improvement’.

We found the practice to be good in the caring and responsive domains and requires improvement in the safe, effective and well-led domains.

Our key findings were as follows:

  • Patients were treated with compassion, dignity and respect.
  • Staff were able to identify and respond to changing risks to patients including deteriorating health and well-being or medical emergencies.
  • Staff understood their responsibilities to raise concerns, and report incidents and near misses.
  • Patients reported good access to the practice, that they had a named GP and continuity of care, with urgent appointments available the same day.

There were areas of practice where Stuart House Surgery need to make improvements. We have asked the practice to take action on six issues where we found that improvements were needed.

Importantly, the provider must:

  • have a robust business continuity plan.
  • ensure that all staff who undertake the role of chaperone must have knowledge, skills and competencies required for the role.
  • have a robust system in place for the recruitment of staff.
  • have a system in place to audit infection prevention and control.
  • have secure systems in place for the management and security of medical records held in paper format.
  • must notify the Care Quality Commission (CQC) of changes, events and incidents affecting their service or the people who use it.
  • have a system in place to manage and learn from concerns and complaints

In addition the provider should:

  • have practice meetings which are regular, structured and relevant to give all staff the opportunity to take part, where information is shared and lessons learnt. For example, significant events and complaints. Meetings should be minuted in order to record summaries of topics discussed and actions to be taken.
  • use translation services to ensure that the practice delivers safe, effective, patient focused care for people who are limited English proficient due to impairment or because their first language is not English.
  • policies in place which are appropriate and regularly reviewed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice