Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Horsefair Surgery on 24 August 2016. The overall rating for the practice was requires improvement with one rating of inadequate for providing effective services, requires improvement for providing safe and well-led services and good for caring and responsive services. We issued requirement notices in relation to breaches of the regulations in safe care and treatment, good governance and staffing. The full comprehensive report from the inspection can be found by selecting the ‘all reports’ link for Horsefair Surgery on our website at www.cqc.org.uk.
We undertook a comprehensive follow up inspection on 9 May 2017. This inspection was undertaken to determine whether improvements were made following the inspection in August 2016. Whilst improvements had been made in relation to some of the concerns highlighted at the last inspection, there were areas relating to patient care and treatment and breaches of regulation which had not been addressed. . The practice is rated inadequate overall and specifically as inadequate for providing effective and well-led services, requires improvement for providing safe services, but good for providing caring and responsive services.
Our key findings were as follows:
- Governance arrangements had not improved since our previous inspection and had not enabled the provider to make improvements to all of the areas where we found breaches of regulations.
- Specifically, those relating to the care and treatment of patients with long term conditions had not been addressed by the practice. Effective action had not been taken to mitigate the risks highlighted and ensure improved patient outcomes.
- National data submissions from 2016/17 showed a decline in performance around the care and treatment of patients with long term conditions.
- Risks related to medicines were not always appropriately managed. Patients’ medicine reviews were still not being recorded or undertaken in line with national guidance to enable appropriate monitoring.
- There was no system in place to monitor outcomes and drive improvements, including completed clinical audit cycles.
- Staff were able to access clinical training in order to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, training requirements were not monitored to ensure they were being undertaken by all staff.
- There was a system in place for reporting and recording significant events. Reviews of complaints, incidents and other learning events were thorough.
- 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. Improvements were made to the quality of care as a result of complaints and concerns.
- Patient feedback in CQC comment cards showed patients were satisfied with the approach of staff and they felt they received a quality service.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- The provider was aware of and complied with the requirements of the duty of candour.
There were areas of practice where the provider needs to make improvements.
Importantly, the provider must:
- Assess, monitor and improve the quality and safety of the services provided in the delivery of care to patients.
- Ensure medicine reviews are recorded in an accurate and timely manner to support patient care.
- Review and improve long term conditions management to ensure improved patient health outcomes.
- Improve the monitoring of clinical care to ensure areas where improvements are required are identified and acted on. For example, through completion of clinical audits.
- Ensure all staff undertake the necessary training related to their roles and appropriate records are kept to monitor training.
- Review policies to ensure they are practice specific and that staff can access the appropriate guidance.
I am placing this service in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.
Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any population group, key question or overall, we will take further 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 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.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice