We carried out an announced comprehensive inspection at Church Lane Surgery on 26 March 2019 as part of our inspection programme.

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 previously carried out an announced comprehensive inspection at Church Lane Surgery on 8th August 2018 and the overall rating for the service was inadequate. We found that the practice was inadequate for providing safe, effective, caring, responsive and well led services. As a result, we issued a requirement notice for regulation 12, safe care and treatment and a warning notice for regulation 17, good governance, to ensure the practice made appropriate improvements.

The service was placed in special measures in October 2018. A further focused inspection was undertaken in December 2018, where we followed up concerns from the warning notice we had issued.

That re-inspection was not given a rating, but we were satisfied that risks had been sufficiently reduced at that time. This inspection was an announced comprehensive inspection carried out on 26th March 2019 to confirm that the service had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspections.

We have rated this practice as requires improvement overall and inadequate for all population groups.

We rated this practice as requires improvement for providing effective services because two population groups are rated as requires improvement because:

• The clinical outcome indicators for 2017/2018 for people with long term conditions and those experiencing poor mental health was below local and national averages. Although the unverified data from 2018/2019 showed an upward trend for those experiencing poor mental health these figures were still below the national averages.

We rated this practice as requires improvement for providing caring services because:

• Patient satisfaction in relation to the health professionals seen at appointments was below local and national averages.

We rated this practice as inadequate for providing responsive services because:

• Patient satisfaction regarding making and accessing appointments was below local and national averages. Although we had acknowledged that the practice had carried out its own patient survey relating to access of appointments and had introduced improvements these still needed to be fully reviewed for their effectiveness.

These areas affected all population groups, so we rated all population groups as inadequate for providing responsive services.

We rated this practice as requires improvement for providing well-led services because:

Although the practice had strengthened its governance structures, which were regularly reviewed, not all improvements had been actioned from the last inspection and although the service had a plan for recruitment activities this had not produced significant improvements on the day of the inspection and therefore we were not assured that improvements could be sustained over time.

We rated this practice as good for providing safe services because:

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

We rated the population groups older people, families, children and young people, working age people and people who were vulnerable in the effective domain as good because we were satisfied that effective services were being provided.

The areas where the practice 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 practice should make improvements are

• Continue to review historic safety alerts based on risk.
• Continue to review and strengthen governance structures and recruitment issues.

This service was placed in special measures in October 2018. We acknowledge the improvements made since the last inspection. However, insufficient improvements have been made such that there remains a rating of inadequate in the responsive domain. The service will be kept under review 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.