We carried out an announced comprehensive inspection at Market Quarter Medical Practice (previously known as Dr Leach & partners) on 14 February 2019. This was to follow up from a previous inspection carried out on 10 January 2018, when the practice had been rated as requires improvement in the areas of providing safe and responsive care which had made the overall rating requires improvement.

At our inspection on 10 January 2018 we found there had been a breach of Regulation 19 HSCA Regulations 2014 Fit and proper persons employed. They had not ensured that all the information specified in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was available for each person employed. We also noted that the practice should make improvements in the following areas:

• Ensure complaints are a standard agenda item at meetings to ensure shared learning.
• Routinely offer health checks to all carers.
• Record any actions taken when a child on the risk register does not attend a hospital appointment.
• Continue to monitor the uptake of cervical screening.
• Continue to improve telephone access and monitor patient satisfaction.

More information regarding that report can be found at: https://www.cqc.org.uk/location/1-569239314

During our inspection on 14 February 2019 we found that the provider had addressed all areas identified although we did not have evidence of the impact of changes implemented regarding access to appointments and getting through on the phone.

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.

We rated the practice as requires improvement for providing responsive services because:

• The practice has had ongoing issues experiencing negative responses from patients regarding telephone access and have made changes to the appointment system. They monitor and review this weekly with the aim of delivering services to meet patients’ needs and plan to continue with this. The practice intended to carry out their own patient survey in March 2019 but at the time of our inspection there was no evidence that the changes had had a significant impact on patients’ access to appointments and getting through on the phone.
• The issue identified affects all population groups, which have therefore also been rated as requires improvement for providing responsive services.

We rated the practice as good for providing safe, effective, caring and well-led services because:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm. They had established systems which all staff were aware of to ensure the safety of patients and staff was maintained.
• We saw that the GPs monitored clinical care via audits and reviews to determine its effectiveness. This ensured patients received effective care and treatment that met their needs and was evident both in the practice’s clinical achievement as well as from patients’ reported satisfaction with the care they received.
• There were systems to support effective governance and staff had allocated roles and responsibilities which they were all aware of and had been appropriately trained to carry out.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care. This was reported by patients on the day of inspection and we observed staff assisting patients with their queries and appointments.
• The management team worked closely together, although formal regular minuted meetings had been less frequent over the last year due to clinical staff changes. However, we noted they had maintained effective communication to promote the delivery of high-quality, person-centred care.
• Staff reported feeling well supported in their work and were encouraged to develop within the practice.

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

The areas where the provider should make improvements are:

• Continue to carry out plans to monitor and increase the uptake of cervical screening.
• Continue to monitor telephone access and access to appointments.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care