We carried out an announced comprehensive inspection at Shadbolt Park House Surgery on 27 March 2019 as part of our inspection programme and to follow up on non-compliance found at the previous inspection. We had previously inspected the practice in July 2018 and November 2017, where the practice had been rated as Requires Improvement (Requires improvement overall and in safe, effective and well led).

At our previous inspection we asked the practice to make improvements in the following areas:

• Ensure care and treatment is provided in a safe way to patients.
• 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.
• Ensure specified information is available regarding each person employed and where appropriate, persons employed are registered with the relevant professional body.

At this inspection we found these issues had been addressed and the practice was now compliant.

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.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• 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.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• There was a clear leadership structure and staff felt supported by management.
• Staff worked well together as a team and all felt supported to carry out their roles. There was a strong team ethos and culture of working together for a common aim.

At the time of the inspection Shadbolt Park House Surgery had no registered manager in post. Registered managers have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Whilst we found no breaches of regulations, the provider should:

• Review training for reception staff in relation to red flag symptoms
• Consider ways to increase identification of patients who are registered with the practice as a carer and review information for carers within the waiting area
• Continue to review and where possible improve exception reporting
• Review if non-prescribing staff require additional consultation time (for example, to see the GP to sign off prescriptions)
• Review and continue to monitor cervical smear screening to meet Public Health England screening targets
• Review the detail of information recorded for significant events and complete reviews looking for trends.

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

Shadbolt Park House Surgery was previously inspected in November 2017 where the practice was rated as Requires Improvement in safe, effective and well led and overall. The concerns found in the three domains affected the six population groups and these were rated as requires improvement as well. When we re-inspected in July 2018 we found that whilst some improvements had been made, including most of the findings of our previous inspection, not all areas of concern had been addressed and new areas of non-compliance had been found.

At this inspection in July 2018 the practice is rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires Improvement

We carried out an announced comprehensive inspection at Shadbolt Park House Surgery on 5 July 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This was because there had been previous breaches of regulations.

The Health and Social Care Act 2008 states that registered providers must have a registered manager. At the time of the inspection Shadbolt Park House Surgery had no registered manager in post. Registered managers have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. On the day of the inspection, we were shown evidence of an application for the new registered manager.

At this inspection we found:

• A number of systems and processes were not operating effectively to keep patients, staff and people visiting the practice safe. Fire safety was not properly assessed or managed, recruitment checks for locum nurses were incomplete and some checks of medicines management were not being performed consistently.
• The practice ensured that care and treatment was delivered according to evidence-based guidelines. However, the recall of patients to attend reviews was not robust.
• Staff treated patients with compassion, kindness, dignity and respect.
• There was some evidence of learning and improvement. However, some of the issues related to concerns that we raised with the practice previously had not been fully addressed. For example, there were gaps in training.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Patients said they were able to book an appointment that suited their needs. Pre-bookable, on the day appointments, home visits and a telephone consultation service were available. Urgent appointments for those with enhanced needs were also provided the same day. However, the practice was having to use locum nurses at the time of the inspection and nurse appointments were limited.
• The practice was equipped to treat patients and meet their needs.
• We observed the premises to be visibly clean and tidy.
• The practice acted on and learned from external safety events as well as patient and medicine safety alerts.
• The practice routinely reviewed the number of GP appointments available.

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

• Ensure care and treatment is provided in a safe way to patients.
• 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.
• Ensure specified information is available regarding each person employed and where appropriate, persons employed are registered with the relevant professional body.

The areas where the provider should make improvements are:

• Consider ways to identify more patients who are carers and strengthen ways in which they can be supported.
• Review patient lists including patients with learning disabilities and strengthen ways in which they can be supported.
• Review ways to increase uptake for cervical screening.
• Continue to review ways to strengthen the flow of information in a timely manner.
• Review exception reporting in some areas of QOF.
• Continue to implement plans for the recruitment of nursing staff.
• Continue to integrate teams working in silos.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Shadbolt Park House Surgery was previously inspected in January 2016 and was rated Good in all domains and overall.

At this inspection in November 2017 the practice is rated as RI overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires Improvement

The practice is rated as requires improvement for providing safe, effective and well led services and; this affects all six population groups:

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

We carried out an announced comprehensive inspection at Shadbolt Park House Surgery on 8 November 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The Health and Social Care Act 2008 states that registered providers must have a registered manager. At the time of the inspection Shadbolt Park House Surgery had no registered manager in post. Registered managers have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. CQC have received confirmation of an application but this is yet to be completed.

At this inspection we found:

• The practice had an open and transparent approach to safety but did not have sufficient effective systems and processes in place to ensure patients were always kept safe. For example, the practice had not completed the required actions after the legionella assessment, a fire risk assessment or fixed wiring testing.
• Staff we spoke with were aware of their responsibilities to raise and report concerns, incidents and near misses. However, during our inspection we found that the practice’s system for recording significant events needed improvement.
• The practice was unable to demonstrate that all staff were up to date with essential training.
• Staff assessed needs and delivered care in line with current evidence based guidance.
• Data from the Quality and Outcomes Framework (QOF) showed the results for practice management of patients with long-term conditions were good.
• Information about services and how to complain was available and easy to understand.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment
• Patients said they were able to book an appointment that suited their needs. Pre-bookable, on the day appointments, home visits and a telephone consultation service were available. Urgent appointments for those with enhanced needs were also provided the same day.
• The practice was equipped to treat patients and meet their needs.
• We observed the premises to be visibly clean and tidy.

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. By establishing more effective and timely ways to record, discuss and learn from significant events.
• 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.
• Ensure that care and treatment is provided in a safe way for service users, by conducting the necessary checks required from the Legionella assessment.
• Ensure that premises and equipment used are properly maintained by conducting a fire risk assessment and fixed wire testing (as required every five years).

The areas where the provider should make improvements are:

• Consider ways to identify and support more patients who are carers.
• Review the number of GP appointments offered on a daily basis.
• Where prescriptions are uncollected review if these need to be seen by a GP before being destroyed.
• Strengthen the system for logging and monitoring hand written prescriptions
• Strengthen contingency plans to ensure there are sufficient numbers of staff in order to meet the requirements of the practice.

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 Shadbolt Park House Surgery on 12 January 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 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.
• Feedback from patients about their care was consistently and strongly positive. 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 sometimes had to wait two weeks to make an appointment with a named GP but felt there was always a continuity of care. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• Views of an external stakeholder were positive and aligned with our findings.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw areas of outstanding practice:

• The practice was able to offer evening appointments (until 9:30pm) and weekend appointments to all their patients. The practice was part of a hub of doctors’ practices that jointly ran these services.
• The practice had installed a Health Pod for patients to use. This is a secure computer system which has the capability to accurately record patient data and take readings, such as weight and blood pressure measurements. Results are automatically recorded onto the patient computer record and are monitored by practice staff to highlight any readings that would need further investigation.

The areas where the provider should make improvement are:

• Ensure that where risk assessments have highlighted areas of improvement, that action plans are created which include completion dates.
• Ensure that overdue appraisals are completed as required.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice