We carried out an announced comprehensive inspection at Sangam Surgery on 26 February 2019 as part of our inspection programme.

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 requires improvement overall.

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

• There were gaps in systems, practices and processes to keep people safe and safeguarded from abuse such as fire, infection control, patients test results, safety alerts and significant events identification and management, and emergency medicines and equipment.

We rated the practice as good for providing effective, caring and responsive services because:

• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

We rated the practice as requires improvement for providing well-led services because:

• The way the practice was led and managed promoted the delivery of effective clinical and person-centre care but there was a lack of management oversight of maintain quality and safety.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review and improve arrangements to consider and implement relevant guidance from bodies such as Public Health England (PHE).
• Review and improve interim arrangements to sustain standards of premises maintenance and decoration.
• Review and improve interim arrangements to ensure patients privacy in reception areas.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sangam Surgery on 4 October 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and generally well managed but there were some gaps in clinicians fire staff safety training and arrangements for COSHH (Control of Substances Hazardous to Health).
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice list was at or beyond the capacity of the premises and the waiting room was cramped. However, the partners had secured funding for new premises to be built and the practice otherwise had facilities and was equipped to treat patients and meet their needs.

• 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 complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Ensure premises improvements are carried through.
• Embed arrangements for staff induction, fire safety training and COSHH.
• Take action to understand and improve its GP Patient Survey satisfaction scores.

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 on 17 December 2015. Overall the practice is rated as requires improvement.

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

• There was an effective system in place for reporting and recording significant events.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had adequate facilities and was equipped to treat patients and meet their needs.
• There was a 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 complied with the requirements of the Duty of Candour.
• Staff generally had the skills, knowledge and experience to deliver effective care and treatment, but not all staff had received training relevant to their role.
• There was an induction procedure, but it was not fully implemented and did not cover important areas such as safeguarding, infection prevention and control, fire safety, health and safety and confidentiality.
• Some systems and processes were not in place, had weaknesses, or were not implemented in a way to keep patients safe. For example there was no health and safety policy and some staff recruitment checks had not been carried out.
• Some systems and processes to manage risk were not in place, for example to ensure safe storage of refrigerated medicines.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary pre-employment checks and that an effective induction process is in place for all staff as appropriate to their role.
• Ensure all staff receive training in annual Basic Life Support (BLS), infection control, fire safety, chaperoning, the Mental Capacity Act 2005, and child and adult safeguarding as appropriate to their role, and that chaperones receive a DBS check or an appropriate risk assessment carried is out.
• Implement systems and processes to monitor and mitigate risks for example a health and safety policy and related audits and risk assessments such as fire safety and legionella.
• Take action to address identified concerns with premises and equipment cleanliness, hygiene and infection prevention and control.
• Take action to ensure safe medicines management.

The areas where the provider should make improvement are:

• Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines for example Gillick competency.
• Introduce a fully documented governance framework.
• Ensure appropriate checks of emergency medical equipment such as the defibrillator and emergency use oxygen, and provide airways and childrens oxygen masks.
• Consider installing a hearing loop and advertising translation services in the reception area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke to patients, staff and relatives. We received feedback on comment cards from patients who attended the surgery on the day of our visit. People told us that the doctors and the nurses always explained to them what was wrong and gave them advice to manage their ailments. One person said. “The staff are friendly. The doctors are very good. They answer all my questions and always explain why they need to change my medication or treatment.”

People's diversity, values and human rights were respected. Staff told us they treated people with respect and as individuals. We observed reception staff and clinical staff interact with people in a polite and professional manner. We looked at patient records and found that the doctors always documented any treatment advice given and any medication given. People told us that it was a partnership and they felt that the doctor always tried to address the conditions they came to be treated for.

The practice conducted audits to ensure that care was delivered consistently. We found that inspection control audits were carried out and recommendations were implemented.

Staff told us that there had not been any recent allegations of abuse. They all knew the safeguarding lead at the practice and told us that they would refer any abuse allegation to the safeguarding lead who would in turn refer it to the local authority and other authorities such as the police if required.