We previously carried out an announced comprehensive inspection at Gordon Street Surgery on 4 December 2017. The overall rating for the practice was inadequate. The practice was rated Inadequate in providing safe, responsive and well-led services and requiring improvement in providing effective and caring services. Breaches of legal requirements were found and requirement notices were served in relation to safe care and treatment, good governance and fit and proper persons employed. The practice was placed in special measures. The full comprehensive report on the December 2017 inspection can be found by selecting the ‘all reports’ link for Gordon Street Surgery on our website at .

This inspection was an announced comprehensive inspection carried out on 24 July 2018 as part of our inspection programme for services rated as inadequate and placed into special measures and to confirm that the practice met the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 4 December 2017.

This practice is now rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? –Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Requires Improvement

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 – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) – Requires Improvement

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.
• Patients found access to appointments had improved. However, patients expressed the difficulty they had in telephone access to obtain appointments first thing in the morning.
• The practice had systems to keep patients safe and safeguarded from the risk of abuse.
• Staff recruitment practices were in line with legal requirements.
• Systems had been implemented to ensure that health and safety risk assessments and staff training were completed.
• Effective systems were in place to monitor training completed by staff.
• 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 patient participation group was active.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. There were some gaps in the practice’s governance arrangements.

The areas where the provider should make improvements are:

In managing risks, issues and performance in particular:

• Develop the staff training matrix to include all in-house training, document the clinical staff competency checks undertaken
• Maintain blood thinning medicine monitoring and prescribing in line with the practice protocol.
• Develop a system to help identify vulnerable adults and Improve clinical practice in coding patients’ medical conditions on the electronic system.
• Patient paper record security system improvements.
• Further develop the significant event system and continue to improve the practice carer register numbers.
• Improve the uptake on the monitoring of long-term condition patients with diabetes and the uptake of cervical and bowel cancer screening.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field CBE FRCP FFPH FRCGPChief 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

This practice is rated as Inadequate overall. We previously inspected the service in October 2014 and rated the practice as Good.

The key questions are rated as:

Are services safe? –Inadequate

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Inadequate

Are services well-led? - Inadequate

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 – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those recently retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

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

We carried out an announced comprehensive inspection at Gordon Street Surgery on 4 December 2017 as part of our inspection programme.

At this inspection we found:

• The practice had systems, processes and practices in place to protect people from potential abuse. Staff were aware of how to raise a safeguarding concern and had access to internal leads and contacts for external safeguarding agencies. However, not all staff had received safeguarding training relevant to their role.

• The practice systems to manage risk so that safety incidents were less likely to happen required strengthening.

• Clinicians knew how to identify and manage patients with severe infections, for example, sepsis.

• Some patients found it difficult to make an appointment by telephone and told us appointments with GPs did not always run on time.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice ensured that facilities and equipment were safe and that equipment was maintained according to manufacturers’ instructions. There were systems for safely managing healthcare waste.

• There was a system to manage infection prevention and control and patients commented that the practice was always clean. However, there was a lack of evidence to show how the action plan was being monitored to assess progress in meeting the requirements of the Infection Prevention and Control (IPC) audit. The IPC policy did not govern practice.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure specified information is available regarding each person employed.

• Ensure, where appropriate, persons employed are registered with the relevant professional body.

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

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

The areas where the provider should make improvements are:

• Carry out fire drills at regular intervals.

• Increase the identification and support to carers on the practice list.

• The induction process for new staff staff should include an assessment of competence. The provider should also review the system for induction of locum staff to ensure they are adequately supported to provide safe care and treatment.

• Review arrangements to protect patient privacy and confidentiality.

• The provider should review its systems to assure itself that all relevant staff know how to respond appropriately in the event of a safeguarding concern and understand their roles in relation to chaperoning.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

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 Collier, Robinson, Gunstone, O’Reilly & Rakkiannan on 21 October 2014. Overall the practice is rated as good.

Specifically, we found the practice to be good in providing safe, effective, caring, responsive services and for being well-led. The practice was found to be good for the services it provided to older people, people with long term conditions, families, children and young people, the working age population and those recently retired, people in vulnerable circumstances and people experiencing poor mental health.

Our key findings were as follows:

• Staff were aware of their responsibilities to raise concerns and report incidents.
• Patient care and treatment was considered in line with best practice national guidelines.
• The practice was clean and hygienic and had arrangements in place for reducing the risks from healthcare associated infections.
• Patients said that they were treated with compassion, dignity and respect. They felt that their GP listened to them and treated them as individuals.
• The practice had a trained team of staff who had expertise and experience in a wide range of health conditions.
• The practice encouraged their patients and staff to share their views.

There were some areas of practice where the provider needs to make improvements.

The provider should:

• Ensure that systems are in place to show that all staff are informed about new guidance. Have a structured approach to meetings to show that sharing and recording of lessons learned from significant events/incidents, and near misses are disseminated to staff. Meetings should be minuted to clearly show what was discussed, action to be taken, by whom and when.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

On the day of our inspection we spoke with eight patients and six members of staff. We did this to help us to understand the outcomes and experiences of selected patients who used the practice. One patient told us, “The service here is absolutely fine. They are quick and thorough. If you have any queries they are happy to help you”. Another patient told us, “Staff are polite and helpful but getting an appointment is a pain in the neck. Once you get an appointment though everything else is great”.

We saw that patients were treated with dignity and respect and that they experienced care and treatment that met their needs. This was because they were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard.

We saw that patients were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had some systems in place for monitoring the quality of service provision but further work was needed to demonstrate compliance with this regulation. We saw that the provider did not always have effective systems in place to monitor the quality of its service or manage risks to the health and welfare of its patients.