When we visited Park Lane Practice on 13 January 2016 to carry out a comprehensive inspection, we found the practice was not compliant with the regulation relating to good governance. Overall the practice was rated as requires improvement. They were rated as requires improvement for providing safe, effective, caring, responsive and well-led services.

On 4 April 2017 we carried out a second comprehensive inspection and found significant areas of concern and breaches of regulations. Overall Park Lane Practice was rated as inadequate and put in special measures. They were rated as requires improvement for providing safe, effective and caring services, and inadequate for providing responsive and well-led services. We issued a warning notice which covered the regulatory breaches we found relating to good governance, which the practice was required to correct.

The full reports on the January 2016 and April 2017 inspections can be found by selecting the ‘all reports’ link for Park Lane Practice on our website at www.cqc.org.uk.

This report covers the announced follow up comprehensive inspection we carried out at

Park Lane Practice on 6 February 2018 to review the actions taken by the practice to improve the quality of care and to confirm that the practice was meeting legal requirements.

This practice is now rated as Requires Improvements overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

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 – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those 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 t

he practice had reviewed and revised many areas of the practice, particularly in relation to management and governance. However, there were still areas which needed to be addressed and some regulations which were not being met. For example:

• 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 system for conducting cervical screening tests was not in line with guidance. These issues had not been identified by management and governance processes.

• Although most patients felt positive about the service they received, the practice was below average for most of its satisfaction scores on consultations with GPs and nurses when compared to local and national averages. We also noted that many of these scores had fallen since the previous survey which we reported on in our previous inspection report.

• Patients found it difficult to use the appointment system.

• The practice had no clear plan to address feedback from patients or how they would use it to improve services.

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

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

This service was placed in special measures in June 2017. Sufficient improvements have been made such that the practice is now rated as requires improvement overall. However, the service remains rated as inadequate for the provision of well-led services.  The service will remain in Special Measures, be kept under review and if needed could be escalated to urgent enforcement action. Another comprehensive inspection will be conducted within six months to check the practice continues to improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

When we visited Park Lane Practice on 13 January 2016 to carry out a comprehensive inspection, we found the practice was not compliant with the regulation relating to good governance. Overall the practice was rated as requires improvement. They were rated as requires improvement for providing safe, effective, caring, responsive and well-led services. The full report on the January 2016 inspection can be found by selecting the ‘all reports’ link for Park Lane Practice on our website at www.cqc.org.uk.

This inspection was also an announced comprehensive inspection and we visited the practice on 4 April 2017. We found the practice had made changes in some areas. However there were still significant areas of concern and our overall rating for the practice is now Inadequate.

Our key findings were as follows:

• When we inspected the practice in January 2016 we found they were in breach of the regulations for good governance and told them they must ensure there were formal governance arrangements in place. On our inspection in April 2017 we found no clear evidence the practice had taken any action to address this. This meant there was a break in the chain of accountability.

• When we inspected the practice in January 2016 we told the practice they must take action in a number of other areas. When we inspected the practice in April 2017 we found no evidence all of these had been addressed in a planned or structured manner. For example, clinical audit.

• Same day appointments were not always available, although the practice was able to make appointments for patients at another service.

• The practice did not adequately promote effective use its appointment capacity.

• Results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was below the local and national averages. Patients we spoke with said it was hard to get through to the practice by phone and hard to get an appointment.

• The practice had systems to minimise risks to patient safety, however these did not always operate effectively. For example references had not been taken for one salaried GP.

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

The areas where the provider must make improvements are:

• Review of their system for promoting the range of appointments available to ensure they make effective use of their extended hours capacity.

• Ensure they have an effective system for patients to access appointments by telephone.

• Develop an induction pack for locum GPs.

• Implement an effective system for monitoring blank prescription forms that is in line with current guidance.

• Ensure they have  a clear governance framework to support the delivery of good quality care and there is documentation relating to the planning and monitoring of services and the identifying, capturing and managing of issues.

• Ensure they have a business plan or similar document, setting out how the practice plans to develop and improve its services.

• Ensure they have a system or plan for assessing, monitoring and improving  outcomes for patients. 

• Ensure staff that triage patients phone calls have received training and are given clear guidance as to the role.

• Improve the recording of discussions and actions agreed during practice meetings and ensure learning points are recorded with enough detail for staff that may not have been able to attend.

In addition the provider should:

• Ensure all learning from complaints is shared with all staff.

• Review how patients are made aware of the practice’s emergency number to use when the surgery is closed.

• Ensure the practice website provides accurate information.
• Ensure references are obtained for all staff employed by the practice.

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 Park Lane Practice, 7-9 Park Lane, Swindon, SN1 5HG on 13 January 2016. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for provision of safe, effective, caring, responsive and well-led services. The concerns which led to these ratings apply to all population groups using the practice.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The majority of information about safety was recorded. However, reviews and follow ups of significant events and incidents were not thorough and lessons learned were not always communicated widely enough to support improvement.
• Risks to patients were not always assessed and well managed. For example, the practice did not have a formal written business continuity and disaster recovery plan.
• We saw the practice was finding difficult to carry out repeat audits which was making it difficult to identify improvement areas and monitor continuous progress effectively.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Most staff had the skills, knowledge and experience to deliver effective care and treatment. However, some staff had not received annual appraisals.
• Results from the national GP patient survey showed less patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment when compared to the local and national averages. However, most of the patients we spoke with on the day of inspection informed us they were treated with respect and involved in decisions about their care.
• Patients said they found it difficult to make an appointment with a named GP and had to wait a long time to get through to the practice by telephone each morning. Urgent and online appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about services and how to complain were available and easy to understand.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• The practice had a limited governance arrangements to enable assessment and monitoring of the service.

The areas where the provider must make improvements are:

• Review the process for investigating and implementing change following incidents, significant events and patient safety alerts to ensure actions are completed. Improve the recording of discussions and actions during practice meetings.
• Develop a comprehensive business continuity plan in order to deal with major incidents such as power failure or building damage.
• Implement and improve a system of clinical audit cycles to ensure effective monitoring and assessment of the quality of the service.
• Ensure all staff have received regular annual appraisals.
• Continue to review the appointments booking system and the waiting time it takes to get through to the practice by telephone.
• Ensure there are formal governance arrangements in place and staff are aware how these operate to ensure the delivery of safe and effective services.

In addition the provider should:

• Implement a system to promote the benefits of bowel screening to increase patient uptake.
• Develop and implement a clear action plan, to improve the outcomes for patients experiencing poor mental health.
• Ensure written consent is appropriately asked for and documented on all patient records.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 6 February 2018 – Requires Improvement).

The key questions were rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection of Park Lane Practice on 6 February 2018. Overall the practice was rated as requires improvement. The comprehensive report for the February 2018 inspection can be found by selecting the ‘all reports’ link for Park Lane Practice on our website at www.cqc.org.uk.

Following the inspection on 6 February 2018, the provider sent us an action plan that set out the actions they would take to meet the breached regulations. We then carried out an announced follow-up comprehensive inspection of Park Lane Practice on 12 September 2018, to confirm 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 6 February 2018. This report covers the announced follow-up comprehensive inspection.

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 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.
• The practice was aware of areas where they were performing worse than local and national averages and provided evidence to demonstrate what action had been taken and improvements made.
• 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:

• The provider should continue to make efforts to increase the programme coverage of women eligible to be screened for cervical cancer.
• The provider should continue to review arrangements for addressing faults with and checking electrical systems.
• The provider should continue its efforts to increase patient satisfaction with services.

The practice is now rated as Good overall.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice