This practice is rated as requires improvement overall.

The key questions are rated as:

Are services safe? – requires improvement

Are services effective? – requires improvement

Are services caring? – good

Are services responsive? – good

Are services well-led? - good

As part of our inspection process, we also look at the quality of care for specific population groups. We have rated the six population groups as follows:

Older People – requires improvement

People with long-term conditions – good

Families, children and young people – good

Working age people (including those recently retired and students – good

People whose circumstances may make them vulnerable – requires improvement

People experiencing poor mental health (including people with dementia) - good

The service had previously been operated by another provider, a partnership of two GPs, and had been inspected in March 2016, when we rated the service as inadequate overall and placed it in special measures. We re-inspected the service in February 2017, focussing on the key questions of Safe, Effective and Well-led. We noted some improvement in respect of the key question Safe and revised its rating from inadequate to requires improvement. However, there had been insufficient improvement in respect of Effective and Well-led and the service remained in special measures.

The current provider, Dr Rajesh Kumar, had worked as a locum for the previous provider. The provider’s two partners resigned on 31 March 2017 and Dr Kumar was awarded the contract by NHS England on 1 April 2017. He was registered with the CQC as a sole practitioner on 14 November 2017. We carried out this comprehensive inspection on 20 March 2018. We noted sufficient improvements to warrant taking the service out of special measures.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen. However, these did not always operate effectively to minimise risks to patients. Staff had not been trained in relation to dealing with suspected cases of sepsis; there was no evidence that sepsis had been discussed at practice meetings and there was no formal guidance available to staff.
• We found that practice staff had not acted in accordance with its policy on monitoring uncollected prescriptions.
• When incidents did happen, the practice learned from them and improved their processes.
• There was no formal system to assess and profile risks for older patients who are frail or for monitoring patients’ unplanned admissions to hospital; NHS health checks for patients aged over 75-years were not being provided.
• Although we saw data that showed clinical performance in most areas had improved since the new provider took over the service, more work was needed, for example in relation to care provided to older people, people with diabetes and patients with learning disabilities.
• Feedback we received from patients was that there were difficulties getting through to the practice by phone and that appointments often ran late. Some patients were unclear over the role of the nurse practitioner and had not been aware when they had been given appointments with the nurse practitioner, rather than a GP.
• Care and treatment was delivered according to evidence-based guidelines.
• The practice monitored patient feedback and instigated actions to address any concerns.
• There was a strong focus on continuous improvement at all levels of the organisation.
• Changes introduced need to become embedded to ensure that patients’ outcomes continue to improve and the provider should continue to engage and work with service commissioners and local networks to ensure the improved service is sustainable.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Continue with work to improve patient outcomes.
• Continue to review and where necessary implement action to improve patients’ telephone access to the service and to reduce waiting times at appointments.
• Provide clarification to patients over appointments with the nurse practitioner.
• Continue to review and where necessary implement action to improve patient satisfaction with consultations.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Berwick Surgery on 19 March 2019 as part of our inspection programme.

At the last inspection in March 2018 we rated the practice as requires improvement overall and for providing safe and effective services because:

• Staff had not been trained in relation to dealing with suspected cases of sepsis; there was no evidence that sepsis had been discussed at practice meetings and there was no formal guidance available to staff.
• The practice staff had not acted in accordance with its policy on monitoring uncollected prescriptions.
• There was no formal system to assess and profile risks for older patients who are frail or for monitoring patients’ unplanned admissions to hospital.
• NHS health checks for patients aged over 75-years were not being provided.

At this inspection, we found that the provider had satisfactorily addressed these areas.

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 and for all population groups.

We have rated the provider good in safe, caring, responsive and well-led because: -

We found that:

• The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• There were adequate in systems to assess, monitor and manage risks to patient safety.
• 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.
• The practice learned and made improvements when things went wrong.
• Staff had the information they needed to deliver safe care and treatment to patients.
• The provider was supported by an effective management and administration team.

We rated the practice as requires improvement for providing an effective service because:

• Although the practice had made improvements following the previous inspection in regard to the areas of older people, sepsis training for staff and monitoring uncollected prescriptions. At the time of the inspection, the practice was unable to fully demonstrate that all staff had the skills, knowledge and experience to carry out their roles.

The areas where the provider must make improvements 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 the duties.

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

• Review the concerns of the patient participation group and respond appropriately.
• Review the take up of immunisations to children to ensure the practice achieves the national target of 90%.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care.