We carried out an announced comprehensive inspection at Central Surgery on 4 March 2019, to check that improvements that had been identified at our inspection of 10 January 2018 had been sustained. At that time the practice was rated good overall with a rating of requires improvement for

safe services. This was because:

• Systems to assess, monitor and mitigate risks relating to the health, safety and welfare of the service user were not sufficient. Some nebules and injection needles had expired.

• Systems relating to the maintenance of records kept in relation to persons employed in the carrying out of the regulated activity were not sufficient. Records of identity and professional registration checks were not consistently kept.

We found that these areas had been adequately addressed.

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 have rated safe, caring, responsive and well-led as good. We have also rated the population groups of older people, people whose circumstances make them vulnerable and people suffering from poor mental health as good.

At this inspection we found:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.

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

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

• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We have rated the practice as requires improvement for providing effective services. This is because three population groups were rated as requires improvement and the ratings aggregated together mean that the effective domain is requires improvement overall. This was because;

• In the population group, patients with long term conditions, the practice had significantly lower than average performance in the majority of the diabetes indicators and higher than average exception reporting.

• In the population group, families, children and young people, Childhood immunisation uptake rates for children aged two were significantly lower than the World Health Organisation (WHO) targets.

• In the population group working age people, the percentage of women eligible for cervical cancer screening at a given point in time, who were screened adequately within a specified period was below the 80% target and below local and national averages.

  The area where the practice must make improvement is:

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

The areas where the practice should make improvements are:

• Monitor the impact of staff training to improve the communication of reception staff.

• Equipment for dealing with clinical emergencies should be checked regularly, including the availability of spare pads for the defibrillator and the availability of a paediatric oximeter.

• Improve the data in relation to anti-biotic prescribing.

• Improve systems for recording consent

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

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

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. The population groups are rated as:

Older People – Good

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 – Good

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

The provider of this service has changed since the last inspection, when the service was placed in a period of special measures. This was an inspection of the new provider, who was one of the partners previously registered with us, so during the course of this inspection, we looked at the issues raised at our last inspection to ensure that the required improvements had been made.

We carried out an announced comprehensive inspection at Central Surgery on 10 January 2018. We also visited the branch surgery at Thorpe Bay as part of this inspection.

At this inspection we found:

• The practice had 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.
• Although the majority of medicines management systems were effective, we found that the system in place for checking expiration dates of nebules and injection needles required strengthening. Systems for following up non-collection of prescriptions also required review.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The majority of patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Although there was a recruitment process in place, records were not always kept of some of the identity and professional registration checks.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice