Letter from the Chief Inspector of General Practice

We undertook an inspection of Falmouth Road Group Practice on 20 October 2016. At this time the service was operated by another provider. The purpose of our inspection was to make an assessment as to whether or not the practice had made sufficient improvement to come out of special measures. We found that the practice had not made sufficient improvement and took action to cancel the provider’s registration.

AT Medics took over Falmouth Road Group Practice in January 2017. The status of being in special measures transfers to the provider who assumes responsibility of a cancelled service if that service was in special measures. We carried out an announced comprehensive inspection at Falmouth Road Group Practice on 26 September 2017 to determine if the practice could be taken out of special measures. Overall the practice is now rated as requires improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, outcomes and learning were not always clear and the practice did not have an effective system which demonstrated action taken in response to safety alerts.
• There were some concerns around the systems used to monitor vaccine fridge temperatures. The practice took action to address the issue with vaccine monitoring within 24 hours of the inspection.
• Most risks in the practice were well managed; however, those associated with infection control were not always monitored or addressed adequately.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the latest published national GP survey, and the Quality and Outcomes Framework (QOF) related to the care given by the previous provider. We were provided with figures from 16/17 which largely related to the performance of the previous provider. However in the period from 17 January 2017 to 31 March 2017 the practice had contributed to 27% of the overall QOF achieved. The practice had undertaken their own survey which showed that patient satisfaction with the care provided had improved in some areas. Feedback from patients we spoke with on the day about the care provided was mixed, although the majority of patients commented that they had noticed improvement since the new provider had taken over the practice.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns though not all complaints were discussed in practice meetings.
• Most patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• Generally the practice had good facilities and was equipped to treat patients and meet their needs. However, we found a several items of expired clinical equipment. The practice disposed of these as soon as we found them.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour and had systems in place to ensure compliance with the duty.

The areas where the provider must make improvement are:

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

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

The areas where the provider should make improvement are:

• Continue to work on systems to ensure that patients with long term conditions are reviewed and monitored when required and share learning from complaints with all appropriate staff.

The practice will remain in special measures and will be re-inspected within a period of six months.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 26 October 2017 – Requires Improvement). The practice was previously operated by another provider. This provider was placed in special measures and subsequently had their CQC registration cancelled. The current provider (AT Medics) began operating the site in January 2017. Special measures transferred to the current provider when they assumed responsibility for the practice. At our last inspection we found that the new provider had not made sufficient improvement to come out of special measures.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Falmouth Road Group Practice on 26 April 2018 to follow up on breaches of regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identified at our last inspection completed on 26 October 2017.

Concerns at our last inspection related to the management of medicines, systems to manage infection control, safeguarding, safety alerts and significant events. We also found that some pathology results had not been actioned within a reasonable timeframe. Our previous report can be found at http://www.cqc.org.uk/location/1-3253726908

At this inspection we found:

That the provider had addressed all of the concerns raised at our previous inspection. In addition the practice continued to work to improve the standard of care and patient satisfaction after taking over operating the service from the previous provider in January 2017.

In addition:

• 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.
• 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.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw one area of outstanding practice:

• All Pharmacists working for the organisation were required to undergo objective structured clinical examination (OSCE) provided through AT Medics. This involved eight stations covering various prescribing areas including depression, contraception and pre diabetes. Each station had an actor and an examiner. Following the exam all pharmacists received individual and collective feedback. If a pharmacist has scored particularly poorly in an area, they would undergo remedial training or focused observation to see if they are safe to continue in that particular area.

The areas where the provider should make improvements are:

• Continue with work to improve the uptake of bowel and breast screening.

• Advertise translation services in the reception area.

I am taking this service out of special measures as a result of the significant improvements that the provider has made.

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