This practice is rated as Requires improvement overall. (Previous inspection 4 February 2016 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

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

We carried out an announced comprehensive inspection at Maylands Health Care on 14 November 2018 as part of our inspection programme.

At this inspection we found:

• The practice worked in partnership with patients and external partners to successfully sustain service delivery for its 14,700 patients from various premises due to a serious flood over eight months from July 2016 to February 2017. During this time, the premises was up to 60cm underwater and drying out for a further three months until spring 2017. Staff and patients explained the practice was still recovering from this major incident that affected business as usual including improving patient access, strategy and oversight, and routine staff checks, annual appraisals and training.
• The practice systems to manage safety and risk were variable. Several risk assessment processes had not been undertaken, were overdue or not followed up. However, patient safety alerts and safety incidents were managed effectively to improve safety.
• 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 but reported that they were not always able to access care when they needed it.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas of practice where the provider must make improvements are:

• 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 of practice where the provider should make improvements are:

• Review and improve insight and understanding of clinical data and elements of patients coding on records.

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 Maylands Health Care on 04 February 2016. Overall the practice is rated as good.

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, recording and learning from significant events.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

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

• Patients said they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

• Patients said they could get an appointment when they need one, including same day urgent appointments.

• Information about services and how to complain was available and easy to understand.

• 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, and was developing policy and practice to ensure that, it complied with the requirements of the Duty of Candour.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

The inspection team consisted of a CQC inspector, a GP and a practice manager. As part of this routine inspection, we followed up on information received alleging there were no disclosure checks for staff. We spoke to the practice manager, two partners, a trainee GP, two nurses, one health care assistant and administration staff. We spoke to 18 patients. Sixteen out of 18 were happy with the care they received. Two out of 18 told us more could be done to manage their multiple long term conditions and ensure that different health care professionals coordinated care and medication reviews.

We found care was assessed and planned according to individuals’ medical conditions. Referrals were made in a timely manner and there were systems in place to follow up referrals made as well as asking the patient to notify the practice if they had not received any confirmation that a referral had been made. Home visits were available for those who needed them and people with palliative care needs were visited weekly.

The practice was accessible via wheelchair, although electric scooters were to be left at reception. Patients told us that getting an appointment over the phone was usually a problem and sometimes they had to wait for over three weeks.

Staff were aware of safeguarding protocols and how to report concerns.

There were systems in place to monitor the quality of care provided. Staff were supported to do their work by appraisals, regular team meetings and feedback on both good practice and areas for development. However, there were gaps in training of administrative staff.