21 August 2018
During a routine inspection
This practice is rated as requires improvement overall. (Previous rating February 2018 – Inadequate)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Requires Improvement
Are services caring? – Good
Are services responsive? – Requires Improvement
Are services well-led? - Good
We carried out an announced comprehensive inspection at St Lukes Surgery on 21/08/2018 to follow up on breaches of regulations. The practice had previously been inspected in February 2018, when it was rated Inadequate overall. Specifically, the practice was rated as inadequate for providing safe, effective, responsive and well-led services. The practice had been rated as good for providing caring services. The practice was placed in special measures.
At this inspection we found:
- There was a new approach to the running of the practice with an open and transparent approach to safety and an effective system in place for reviewing and recording areas for improvement.
- The practice was in the process of merging with another GP practice, the Living Well Partnership. The practice had commenced the merger with the Living Well Partnership in October 2017 to promote sustainability and to share services for patients. We found that the merger of shared systems and processes had almost been completed.
- Senior managers had assumed responsibility for overseeing different areas of governance and leadership and had implemented an organisation hierarchy of line management and accountability.
- The practice had implemented clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
- There were gaps in staff training and not all staff had received an annual appraisal.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patient feedback regarding the ease of accessing care remained mixed. The practice had made some changes to improve access for patients but new systems were not embedded.
- Staff reported feeling well supported by leaders and there was a focus on continuous learning and improvement at all levels of the organisation.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out duties.
- 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 review prescribing for some less recommended antibiotics to reduce the number of items prescribed, in line with local and national averages.
- Review processes which enable staff to access policies and procedures.
- Review registration to reflect changes made to the provider and partners.
This service was placed in special measures in February 2018. Sufficient improvements have been made such that St Lukes Surgery has now been rated as Requires Improvement. I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice