We previously carried out an announced comprehensive inspection at Foden Street Surgery on 19 September 2017. The overall rating for the practice was good with requires improvement for providing a safe service. 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 19 September 2017 inspection can be found by selecting the ‘all reports’ link for Foden Street Surgery on our website at www.cqc.org.uk

This inspection was an announced comprehensive inspection carried out on 23 October 2018 as part of our inspection programme for services rated with a 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 19 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? - Good

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.
• The practice evidenced their attempts to improve patient engagement, through surveys, and via the Patient Participation Group.
• The practice continued to advertise for another GP and had successfully recruited a self-employed nurse practitioner prescriber.
• The practice held regular joint clinical governance meetings with another practice in which patient safety alerts and learning from significant events and complaints were shared.
• Staff who provided a chaperone service had been in receipt of appropriate training.
• The practice had ensured health and safety checks were undertaken within the recommended timescales.
• The practice had improved the number of carers registered.
• The practice had improved the arrangements for advising patients of the appointment system.
• The complaints and suggestions leaflets were readily accessible to patients.
• 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.

The areas where the provider should make improvements are:

• Fully implement the written consent document for minor surgical procedures.
• Improve the monitoring of the transportation of vaccines.

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 carried out an announced comprehensive inspection at Foden Street Surgery on 19 September 2017. Overall the practice is now rated as Good.

The practice was formerly a GP partnership, known as The Surgery- Foden Street, and had previously been inspected on 23 November 2015. Following this comprehensive inspection the overall rating for the practice was Requires Improvement. We found four breaches of the legal requirements and as a result we issued requirement notices in relation to:

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Safe care and treatment.

Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Good Governance.

Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Staffing.

Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Fit and proper persons employed.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Foden Street Surgery on our website at www.cqc.org.uk.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• There was a system in place to log, review, discuss and act on external alerts, such as the Medicines and Healthcare products Regulatory Agency (MHRA) alerts.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. 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.
• Information about services and how to complain was available but not readily accessible. Improvements were made to the quality of care and access to services as a result of complaints and concerns.
• 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.
• There was a clear leadership structure in place and staff felt supported by the management team. The practice responded positively to feedback from staff and patients.
• The practice had effective procedures for the storage of emergency medicines and regular checks were undertaken to ensure medicines were fit for use.
• Effective systems were in place for identifying and assessing the risks to the health and safety of patients and staff. However, not all of the required health and safety checks had been undertaken.
• Patients found it easy to make an appointment, with urgent appointments available the same day.
• Data from the Quality and Outcomes Framework showed patient outcomes were higher than average when compared to the local and national averages for most clinical indicators.
• Governance arrangements had improved. There was effective clinical leadership in place and staff were aware of their roles and responsibilities. The provider had acquired a practice manager mentor to support the practice management team to review and further develop the administrative governance arrangements in place.
• The practice was well equipped to treat patients and meet their needs.

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:

• Carry out a regular analysis of significant events to identify any common trends, maximise learning and help mitigate further errors.

• Ensure health and safety checks are undertaken at the recommended timescales.

• Consider identifying and improving the number of carers registered.

• Consider expanding the availability of staff to chaperone to provide a more flexible service for patients.

• Improve the arrangements for advising patients of the appointment system.

• Consider making the complaints and suggestions leaflet more readily accessible.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice