Patford House Surgery Partnership

Updated 11 May 2022

Patford House Surgery Partnership is a three site GP practice with a patient list size of approximately 15,750 and based in Calne and Sutton Benger in Wiltshire. In April 2019, Beversbrook Medical Centre and Patford House Surgery merged to form Patford House Surgery Partnership.

The practice is part of the Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Group (CCG). (A CCG is responsible for planning and designing local health services in a specific geographic area. They do this by 'commissioning' or buying health and care services).

GP services are provided from three different sites:

• Patford House Surgery, 8a Patford Street, Calne, Wiltshire SN11 0EF

• Beversbrook Medical Centre, Harrier Close, Calne, Wilshire SN11 9UT

• Sutton Benger Surgery, Chestnut Road, Sutton Benger, Chippenham, Wiltshire SN15 4RP

At the Sutton Benger Surgery, dispensing services are provided to registered patients who live more than a mile away from a community pharmacy.

All three sites were visited as part of this inspection.

The practice website is: www.patfordhousepartnership.com

The provider is registered with CQC to deliver the following Regulated Activities from all three sites:

• Diagnostic and screening procedures
• Family planning services
• Maternity and midwifery services
• Surgical procedures
• Treatment of disease, disorder or injury

The partnership includes, two GPs and one managing partner. Three salaried GPs are also employed, and the practice employs locum GPs when there is a need. In addition, the clinical team comprises of a range of clinicians including advanced nurse practitioners, nurse practitioners, practice nurses, a paramedic, physiotherapists and healthcare assistants. One of the GPs is the designated dispensary lead and the combined dispensary team consists of six team members.

The managing partner and other departmental managers and a team of reception and administrative staff undertake the day to day management and running of the practice.

The practice has core opening hours between 8am and 6.30pm, Monday to Friday. The dispensary in Sutton Benger has core opening hours between 10am and 4.30pm every weekday except Tuesday when the dispensary is closed.

When the practice is closed out of hours services are provided by Medvivo which patients can access via the NHS111 service.

Updated 11 May 2022

We carried out an unannounced comprehensive inspection at Patford House Surgery Partnership in May 2021. The overall rating for the practice was Inadequate, specifically Inadequate for the provision of responsive and well-led services and Requires Improvement for the provision of safe, effective and caring services. We used our enforcement powers to take action against the breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 including issuing two warning notices. We placed the practice in special measures to enable the practice to improve.

We undertook a further inspection in November 2021. This inspection was undertaken to determine whether the breaches of regulation had been addressed following the inspection in May 2021 and did not provide a new rating. Whilst improvements had been made in relation to the high-risk concerns highlighted at the last inspection, there were several areas which constituted new and continued breaches of regulations.

At this inspection in March 2022, we found that significant improvements had been taken to improve the provision of care and treatment. Following the March 2022 inspection, we have provided a new overall rating of Good and the key questions have been rated as:

• Safe - Good
• Effective - Good
• Caring - Good
• Responsive – Requires improvement
• Well-led - Good

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

Why we carried out this inspection

This inspection was a comprehensive inspection of all key questions, to follow up on breaches of regulations and to apply an updated rating for the practice.

How we carried out the inspection

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:

• Conducting staff interviews
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider
• Reviewing patient records to identify issues and clarify actions taken by the provider
• Requesting evidence from the provider including the action plan following the last inspection
• Site visits to all three sites
• Discussions with practice staff, local care homes who access GP services from the practice and the patient participation group

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 rated this practice as Good overall

We found that:

• It was evident the practice had gone through a period of transition. This included merging practices in 2019, the COVID-19 pandemic, addressing concerns from past CQC inspections and significant staff changes within all the teams in the practice.

• The practice had, with the support of the clinical commissioning group (CCG) and additional external resources, made significant improvements to provide care in a way that kept patients safe and protected them from avoidable harm.

• These systems were newly implemented and required further embedding to ensure the practice would be able to sustain and make further improvements to ensure they were effective.

• The practice had been challenged with some staff changes and difficulties in recruiting clinical members of staff, however, they used locums who provided sessions on a regular basis. The practice had an active recruitment drive in place and had recently employed new members of staff to join the different teams within the practice.

• We reviewed patient consultation records and found examples of appropriate clinical interventions, monitoring, prescribing and coding, ensuring accurate information was available for any health professional that required it.

• Patients received effective care and treatment that met their needs.

• Personal development and learning was actively promoted and a wide range of learning opportunities were provided for staff of all grades and disciplines.

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.

• The practice ensured learning from complaints was shared effectively with staff and demonstrated that all complaints had been acted in line with practice policy and national guidance around response timescales.

• The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. However, patient feedback and satisfaction was low and highlighted further adjustments needed to be made in response to accessing services.

• The practice had an effective governance system in place, was well organised and actively sought to learn from previous inspections, performance data, complaints, incidents and feedback.

The practice had engaged with the findings of our last report, had worked with the local CCG and other external teams to identify the recovery plan, make the changes, monitor and ensure those improvements were sustainable. Relationships had been made with the external team to strengthen the leadership, and feedback from staff was positive about the changes and future. However, where improvements had been made the practice needed to ensure they were fully embedded, monitored and sustained.

Whilst we found no breaches of regulations, the provider should:

• Continue to work with the CCG and other external stakeholders to improve communication and teamwork across the local health economy.
• Review the practice website and include information and contact details about local and national support services.
• Continue to review and improve patient access to services.
• Continue to embed, further improve and sustain the newly implemented systems and processes to provide safe, effective and responsive care.

I am taking this service out of special measures. This recognises the improvements that have been made to the quality of care provided by this service.

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