We carried out an announced comprehensive inspection at Halfway Surgery on 21 August 2018. The overall rating for the practice was good. However, the practice was rated requires improvement for providing safe services and a Requirement Notice was served in relation to breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12 Safe care and treatment, found at this inspection. The full comprehensive report on the August 2018 inspection can be found by selecting the ‘all reports’ link for Halfway Surgery on our website at www.cqc.org.uk.

After our inspection in August 2018 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the Requirement Notice served.

This inspection was an announced focussed follow-up inspection carried out on 30 October 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 21 August 2018. This report only covers findings in relation to those requirements.

Our judgement of the quality of care at this service is based 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.

This practice is rated as good overall. However, the practice remains rated as requires improvement for providing safe services.

At this inspection we found:

• All electrical equipment had been checked to help ensure it was safe to use.
• Improvements to the system that managed infection prevention and control had taken place.
• The practice had made improvements to fire safety management.
• Improvements to the arrangements for managing medicines in the practice had taken place. However, further improvements were still required.
• The practice had continued to monitor and improve patient uptake for breast and bowel screening.
• The practice had continued to implement and monitor the effectiveness of the action plan to carry out all remaining physical and medicine reviews for patients with learning disabilities.
• All staff who acted as a chaperone had received training for this role.
• The practice had continued to monitor and improve national GP patient survey patient satisfaction scores.

The areas where the provider must make improvements are:

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

The areas where the provider should make improvements are:

• Continue with plans to train fire marshals.
• Continue to monitor and improve patient uptake for breast and bowel screening.
• Continue to implement and monitor the effectiveness of the action plan to carry out all remaining physical and medicine reviews for patients with learning difficulties.
• Continue to monitor and improve national GP patient survey patient satisfaction scores.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

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

This practice is rated as Good overall.

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

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 Halfway Surgery on 21 August 2018 under Section 60 of the Health and Social Care Act 2008, as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• There was an effective system for reporting and recording significant events.
• All electrical equipment had not been checked to help ensure it was safe to use.
• The system to manage infection prevention and control was not always effective.
• The practice’s fire safety risk assessment failed to identify all potential risks.
• The arrangements for managing medicines in the practice did not always keep patients safe.
• The practice routinely reviewed the effectiveness and appropriateness of the care they provided. They ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.
• There were clear responsibilities, roles and systems of accountability to support good governance and management.
• The practice had systems and processes for learning, continuous improvement and innovation.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

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

The areas where the provider should make improvements are:

• Continue to monitor and improve patient uptake for breast and bowel screening.
• Continue to implement and monitor the effectiveness of the action plan to carry out all remaining physical and medicine reviews for patients with learning difficulties.
• Consider the risks associated with using staff as chaperones who have not been trained for the role.
• Continue to monitor and improve national GP patient survey patient satisfaction scores.

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.