The Care Quality Commission
  • Doctor
  • GP practice

Maple Access Surgery

Overall: Good read more about inspection ratings

Maple House, 17-19 Hazelwood Road, Northampton, Northamptonshire, NN1 1LG (01604) 250969

Provided and run by:
Maple Access Partnership

Important: We are carrying out a review of quality at Maple Access Surgery. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

18 May 2021 and 19 May 2021

During a routine inspection

We carried out an announced follow up comprehensive inspection at Maple Access Surgery on 18 and 19 May 2021.

Maple Access Surgery had been inspected previously:

The overall rating from the inspection on 7 May 2019 was Inadequate, with Requires Improvement in caring and responsive. The practice was placed in special measures.

  • At the follow up comprehensive inspection on 17 December 2019, the practice was rated as Requires Improvement with ratings of Good for providing safe and caring services. Insufficient improvements had been made and a rating of Inadequate for the working age population group meant the practice remained in special measures.
  • The full comprehensive report on the May 2019 and December 2019 inspections can be found by selecting the ‘all reports’ link for Maple Access Surgery on our website at www.cqc.org.uk.

At the last inspection we identified the following areas for improvement:

  • Some performance data was significantly below local and national averages.
  • Exception reporting was high and although the practice was working to reduce this, further improvement was needed.
  • Cancer screening and immunisation rates were significantly below national averages.
  • Systems and processes to ensure Good governance in accordance with the fundamental standards of care required had not always identified the shortfalls within the service.
  • Complaints were not being effectively managed and responded to.

We were mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what type of inspection was necessary and proportionate. This was why there was a delay in re-inspecting this service.

We carried out a follow up comprehensive inspection on 18 and 19 May 2021 to confirm that the practice had resolved the outstanding issues from the previous inspections.

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 using video conferencing
  • 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
  • A short site visit

We found the practice had made improvements at this inspection.

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.

Key findings included:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • Patient group directions (PGDs) ensured staff had the appropriate authorisations to administer medicines.
  • Increased review and monitoring of patients care plans had seen a reduction in some areas of personalised care adjustment (PCA), although the practice told us their patient demography was a contributory factor in higher rates of adjustments.
  • Parents of children who were overdue immunisations were contacted in a variety of ways, including follow-up contact by nurses at the practice. They also discussed immunisations opportunistically with parents and actively communicated with local community groups to educate and encourage parents to take their children for vaccinations.
  • The practice had worked to improve cervical screening uptake through various means including sending out personal reminders following failed appointments, liaising with local groups and religious leaders to improve uptake for all the national screening levels.
  • Systems and processes had improved and now ensured Good governance to identify and act on the shortfalls within the service. This included systems for staff training and monitoring completion, and the management of complaints.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

17 December 2019

During a routine inspection

We carried out a follow up comprehensive inspection at Maple Access on 17 December 2019, following an inspection on 7 May 2019 which rated the practice as Inadequate. We took enforcement action against the provider and placed the practice in special measures at that time.

At this inspection we also followed up on breaches of regulations 17 (Good Governance) and 18 (Staffing) identified at a previous inspection on 7 May 2019.

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 requires improvement overall.

We rated the practice as requires improvement for providing effective, responsive and well-led services because:

  • Some performance data was significantly below local and national averages.
  • Exception reporting was high and although the practice was working to reduce this, further improvement was needed.
  • Cancer screening and immunisation rates were significantly below national averages and although the practice was working to improve this, further improvement was needed.
  • Systems and processes to ensure good governance in accordance with the fundamental standards of care required had not always identified the shortfalls within the service.
  • Complaints were not being effectively managed and responded to.

We rated the practice as good for providing safe and caring services because:

  • The premises were now being managed safely and staff reported to feel safe working at the practice.
  • Emergency medicines were in place as required.
  • Recruitment checks were now being done as required and staffing levels were sufficient.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • Patient feedback about improvements in patient care was positive and reflected the improvements made at the practice since our last inspection.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Continue to improve the uptake of patients for the national cancer screening programme and child immunisations.
  • Continue to improve the performance rates for the prescribing of Hypnotics at the practice.
  • Continue to reduce the exception reporting at the practice.

This service was placed in special measures in June 2019. We acknowledge the improvements made since the last inspection. However, insufficient improvements have been made such that there remains a rating of inadequate for working age people. The service will therefore remain in special measures and another inspection will be conducted within six months and if there is not enough improvement, we will review the position and consider whether there is a need to take further action.

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

7 May 2019

During a routine inspection

We carried out an announced comprehensive inspection at Maple Access on 7 May 2019.

We last inspected this practice on 6 October 2014 when we rated the practice as Good.

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 inadequate overall.

We rated the practice as inadequate for providing safe services because:

  • The practice did not have clear systems and processes to keep patients safe.
  • Staff did have all the required recruitment checks in place.
  • The premises were not being regularly assessed to ensure their safety. This posed a risk to patients and staff at the practice.
  • The practice did not have all of the required emergency drugs in stock to ensure patient safety.
  • The practice did not have an adequate system in place to safely manage MHRA and other safety alerts.
  • Risks to staff and patients at the practice had not been adequately assessed, monitored and planned for.

We rated the practice as inadequate for providing effective services because:

  • There was limited monitoring of the outcomes of care and treatment.
  • The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.
  • Some performance data was significantly below local and national averages.
  • Exception reporting was high with little evidence of how the practice was working to reduce this.
  • Cancer screening and immunisation rates were significantly below national averages and the practice was failing to address this.

We rated the practice as requires improvement for providing caring and responsive services because:

  • There was limited evidence in relation to how patients could feedback on how the practice was run.
  • The practice had not made the changes it needed to in order to respond to the needs of the patients who used the practice who had complex health needs.

We rated the practice as inadequate for providing well-led services because:

  • Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
  • The overall governance arrangements were ineffective due to areas of risk which had not been identified prior to our inspection.
  • The practice did not have clear and effective processes for managing risks.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure sufficient numbers of skilled and experienced staff are employed at the practice to deliver safe care and treatment.

The areas where the provider should make improvements are:

  • Improve the uptake of patients for the national cancer screening programme.
  • Improve the uptake of child immunisations.
  • Reduce the exception reporting at the practice.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take 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 to 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 by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

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

6 October 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We visited Maple Access Partnership on the 6 October 2014 and carried out a comprehensive inspection. The practice offers a satellite clinic at Oasis House, which is a homeless support centre but we did not inspect that venue.

The overall rating for this practice is good, with areas of outstanding practice for vulnerable groups of people, which includes substances misusers and homeless people, as well as those with mental health needs where the practice has a special interest and has developed tailor made services for their patients.

Our key findings were as follows:

  • Patients were satisfied with the service and felt they were treated with dignity, care and respect and involved in their care.
  • There were systems in place to provide a safe, effective, caring and well run service.
  • There was a good understanding of the needs of the practice population and services were offered to meet these.

We saw areas of outstanding practice including:

  • The practice’s approach to mental health and services for vulnerable people, including the homeless and substance misusers. They had developed a specialist, non stigmatising service which provided easier access and support for patients who had difficulty in accessing health services or were in crisis. The practice had developed relationships with other agencies to build services and ensure that patients accessed the appropriate support when they needed it and so that all professionals involved in care were aware of the issues facing this vulnerable group of patients.
  • The practice offered specialised satellite clinics four times a week at a homeless support centre and worked with the local agencies, such as the local council, police and other agencies of support. This facilitated development of a co-ordinated approach and provided patients with access to care when they needed it. They offered a drop in session daily for people who misused drugs to allow them to access help if in crisis.
  • They had developed different means of communication to help patients remember to attend appointments, such as text reminders and had also introduced a means of allowing hearing impaired patients to book their appointments by text messaging.

However, there were also areas of practice where the provider should make improvements.

The provider should:

  • Ensure their clinical audit process is scheduled, completed and includes minor surgery complications including coils and contraceptive implants.
  • Ensure that any staff who may at any time be required to act as a chaperone has received the appropriate training.
  • Document that any non-clinical staff who had not received a Disclosure and Barring Service (DBS) check had been risk assessed before commencing employment.
  • Ensure that all policies and protocols are updated and reflective of practice that staff should carry out.
  • Carry out minor repairs in the treatment room as identified in this report.
  • Amend the Controlled Drug policy to include instructions for circumstances when patients may bring in their controlled drugs for administration.
  • Review their policy regarding texting patients with results to account for when young people become 17 years of age. Currently there is no system to ensure a change or review of young peoples’ contact telephone numbers when they reach the age of 17 as prior to this age they are often registered with their parents contact number. This may result in a breach of confidentiality.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice