We previously carried out an announced comprehensive inspection at Dr C Stephenson & Partners on 5 September 2017. The overall rating for the practice was requires improvement. The practice was rated requires improvement in providing safe and effective services. A breach of legal requirements was found and a requirement notice was served in relation to fit and proper persons employed. The full comprehensive report on the 5 September 2017 inspection can be found by selecting the ‘all reports’ link for Dr C Stephenson & Partners on our website at

This inspection was an announced comprehensive inspection carried out on 1 October 2018 as part of our inspection programme for services rated as requires improvement, and to confirm that the practice met the legal requirements in relation to the breach in regulations identified in our previous inspection on 5 September 2017.

This practice is rated as Good overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - RI

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.
• Recruitment procedures had improved. However, the system in place to ensure that all clinical staff were covered by medical indemnity required improvement.
• Staff at the practice had been subject to a fire drill and the staff who attended where identifiable via the staff rota.
• 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. The clinical audits we reviewed were seen to drive improvements in practice.
• End of Life care was a practice focus for the forthcoming year including completing the Marie Curie Daffodil Standards. The Daffodil Standards help GPs to assess and improve the end of life and palliative care they provide to their patients. These were developed in partnership with the Royal College of General Practitioners (RCGP) and Marie Curie.
• Medicine management for uncollected prescriptions had improved.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Staff who provided a chaperone services had been in receipt of training.
• Patients reported difficulties with the appointment system, including telephone access. The practice demonstrated that they had responded to patient feedback and made improvements. Access to appointments for urgent or same day appointments were available.
• Staff reported positively on the impact of having weekly whole practice meetings, improved communication and on-going training on their morale and job satisfaction.
• The practice management had workforce planned and reviewed staff skill mix to meet the needs of their registered population.
• Staff contact numbers were now recorded in the practice major incident/business continuity plan.
• There was a strong focus on continuous learning and improvement at all levels of the organisation and the practice is a GP training practice.

The areas where the provider should make improvements are:

• Introduce a system which enables clear oversight on clinical staff indemnity insurance.
• Continue to review the electronic policy and procedure systems to enable ease of access for staff.
• Regularly review the risk assessment now in place for medicines not held at the practice for use in an emergency.
• Implement safeguard policy updates in line with local and national guidance changes.
• Improve staff awareness on how to check that the vaccine fridge temperature ranges are appropriately set.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr C Stephenson and Partners (formally registered as Drs Przyslo and Partners) on 12 September 2016. The overall rating for the practice was Requires Improvement. We rated the practice as requires improvement for four of the five key questions we inspect against and issued three requirement notices. The practice provided us with an action plan detailing how they were going to make the required improvements in relation to:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Safe care and treatment.
• Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Receiving and acting on complaints.
• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Good governance.

You can read the report from our inspection on 12 September 2016 by selecting the 'all reports' link for Dr C Stephenson and Partners on our website at www.cqc.org.uk.

We undertook an announced comprehensive follow up inspection of Dr C Stephenson and Partners on 5 September 2017. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements. The findings of the inspection were that whilst the provider had taken action to meet the requirement notices, they were not always sufficient to make a significant improvement and as a result the practice continues to be rated as requires improvement.

Our key findings were as follows:

• Improvements had been made to the way significant events were managed. Staff understood and fulfilled their responsibilities to raise concerns. There was a strong culture to report incidents and near misses. Events were recorded, investigated and shared. However, there was no systemised way of summarising learning from events for quality improvement.
• The practice had safeguarding procedures in place. Staff demonstrated that they understood their responsibilities and most had received training on safeguarding children and vulnerable adults relevant to their role.
• There were systems in place for identifying, assessing and mitigating most of the risks to the health and safety of patients and staff. However, some health and safety checks had not been carried out at the recommended frequency.
• There were systems in place for the effective monitoring and prescribing of high risk medicines.
• Data continued to show that the practice had a significant number of patients who had been recorded as clinical exceptions to receiving treatment or interventions.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver care and treatment.
• Patients said they were treated with kindness, dignity and respect and they were involved in their care and decisions about their treatment.
• Data from the national GP patient survey published in July 2017 showed patients rated the practice in line with others for most aspects of care.
• Improvements had been made to the investigation of and learning from complaints.
• Patients we spoke with told us it was easier to contact the practice by telephone following the recent implementation of the new telephone system and there was improved access to appointments.
• There was a staffing structure in place and staff were aware of their own roles and responsibilities.
• There had been significant changes in staffing and challenges within the team since the last inspection. New clinical leadership and structure was being developed and implemented but not yet fully embedded. Key roles and responsibilities had been developed across the team. Staff reported significant improvement in staff morale, the support they received and team working and were starting to enter a period of stability with the change in partnership and a review of staff skillset.

The areas where the provider must make improvement are:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

• Review the process for the monitoring of uncollected prescriptions.
• Ensure information regarding staff physical health or mental health is obtained as part of the recruitment process and copies of all other required documents are readily accessible.
• Include emergency contact numbers for staff within the practice’s business continuity plan.
• Ensure alerts are placed on the electronic records of children whose parents are subject to domestic abuse to ensure clinicians are alerted to the situation.
• Consider providing chaperone training for staff that undertake this role.
• Ensure fire drills are carried out at the recommended frequency.
• Carry out a regular analysis of significant events for purposes of quality improvement.
• Continue to investigate the reasons for higher than average clinical exception reporting data.
• Develop a programme of clinical audit to evidence improved patient outcomes.
• Consider making local safeguarding contact details more readily accessible.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Przyslo and Partners on 12 September 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews and investigations were not thorough enough.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Staff worked with other professionals to improve the care offered for patients with dementia and substance misuse tendencies.

• Patients told us that it was difficult to contact the practice by telephone and future appointments could only be booked by online methods. Some patients told us they did not have internet access and they had no option but to call the practice on the day they needed an appointment.

• The practice recorded complaints although investigation into them lacked detail? and did not consider the factors that contributed to the event.

• Data showed that the practice had a significant number of patients who had been recorded as clinical exceptions to receiving treatment or interventions. Staff were not aware of this outlying data and the reasons for it.

The areas where the provider must make improvements are:

• Improve the process for investigating, reviewing and learning from significant events.

• Improve the quality and experience of the service for patients attempting to contact the practice investigating the reasons for higher than average clinical exception reporting data and lower than average patient satisfaction for contacting the practice by telephone and making appointments.

• Improve the investigation of, and learning from, patient complaints.

• Improve the quality of record keeping for management of delivering services, for example meeting minutes.

In addition the provider should:

• Review the practice cold chain policy to reflect any changes in guidance or practice since the last update.

• Consider expanding the emergency medicines held to include anti-histamine medicine or risk assess why this is not necessary.

• Review the methods for patients who are wheelchair users to gain access to staff within the reception area.

• Review the practice business plan to ensure alignment with the services provided.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice