We carried out an announced comprehensive inspection at Martock Surgery on 2 April 2019 as part of our inspection programme. Martock Surgery became part of Symphony Healthcare Services in December 2018. This was its first inspection under the new provider.

We based our judgement of the quality of care at this service 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.

We have rated this practice as good overall and good for all population groups, apart from patients with long term conditions and patients experiencing poor mental health (including dementia), which we rated as requires improvement.

We found that:

• 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.
• The practice directly employed health coaches to promote patients to have healthier lifestyles, run activity groups, provide signposting patients to other services and act at carers champions.
• The practice offered extended hours which included opening on late evenings and on Saturday mornings.
• There was a programme of annual reviews of patients with long term conditions, mental health needs and dementia, although improved regarding the previous year’s information they were still below the expected local and national targets in some areas.
• The patient participation group (PPG) was beginning to have a positive effect to keep patients informed and involved in the practice and the services it provides.
• There was an active programme of audit that had a positive impact upon the outcomes for patient care, learning was shared across the provider organisation.
• The new provider’s policies and procedures and system of governance which had been implemented and embedded showed there was an effective system of monitoring at the local level and at provider level.
• The practice identified military veterans in line with the Armed Forces Covenant 2014. This enabled priority access to secondary care to be provided to those patients with conditions arising from their service to their country.
• At the time of our inspection the practice manager and deputy practice manager had recently vacated their roles. Symphony Health Services (SHS) was providing management support and a recruitment process had been instigated for these roles.

Importantly, we identified an area where the practice must make improvements;

• The provider must ensure that the monitoring of patients registered with long term conditions, mental health needs and dementia received regular reviews of their care.

In addition, the provider should:

• Continue to deploy resources to address the administrative backlog of work.
• Ensure that management vacancies at the practice are filled in a timely manner to minimise disruption to the service.
• Continue to focus on increasing the number of cervical smear checks and other cancer screening, in line with national guidance.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care