We had previously carried out an announced comprehensive inspection at Spring Street Surgery in July 2018. The overall rating for the practice was inadequate and it was placed into special measures. The practice was rated as inadequate in safe, effective and well-led, and good in caring and responsive. The full comprehensive report on the July 2018 inspection can be found by selecting the ‘all reports’ link for Spring Street Surgery on our website www.cqc.org.uk

At the July 2018 inspection we found that the provider had not:

• Ensured care and treatment was provided in a safe way to patients.
• Ensured patients were protected from abuse and improper treatment.
• Established systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensured persons employed in the provision of the regulated activity received the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Ensured specified information was available regarding each person employed and where appropriate, persons employed were registered with the relevant professional body.

There were also areas where the provider should make improvements by:

• Considering ways to identify more patients who are carers and strengthen ways in which they can be supported.
• Reviewing ways to increase uptake for cervical screening.
• Reviewing meeting structures for non-clinical staff and the frequency of attendance of clinical staff to ensure greater shared learning.
• Reviewing how information is displayed for patients who wish to make a complaint.

We carried out an announced inspection at Spring Street Surgery on 30 April 2019. This was to confirm the practice had carried out their plan to make the improvements required as identified at our previous inspection on 18 July 2018. We found that the practice had made significant improvements.

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 for providing safe care.

We have rated this practice as requires improvement for providing safe care because:

• Patient Safety Alerts were not always recorded as being actioned appropriately.
• Fridge Temperatures had not been recorded on several days throughout December 2018 and this had not been checked, actioned or raised as a significant event.
• Significant events were being appropriately recorded and actions taken but outcomes were not centrally recorded or dated.
• Staff recruitment files held the appropriate information with the exception of one locum GP file we reviewed.

We have rated this practice as good overall and good for all population groups.

We rated the practice good for providing effective, caring, responsive and well-led care because:

• The practice had reviewed all of their QOF data and could show evidence that their performance had significantly improved, including reducing the number of patients that were exception reported.
• Patient Group Directives had been reviewed and were up to date and signed by the appropriate staff members.
• Staff had received the appropriate training for both safeguarding vulnerable adults and children.
• Policies and procedures, including those for safeguarding, had been streamlined and held appropriate information which was easy for staff to find.
• Staff had received an appraisal and all mandatory training was up to date.
• 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.
• The practice had increased the number of carers on their register.
• The practice had increased the uptake of cervical screening.
• The practice had reviewed the meeting structure and staff informed us these were informative and allowed for open discussions.
• The complaints procedure was on display in the reception area and on the practice website.

The areas where the practice must make improvements are:

• Ensure care and treatment is provided in a safe way to patients

This service was placed in special measures in July 2018. The practice has made significant improvements and is now rated good overall and for effective, caring, responsive and well-led and requires improvement for safe. I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service. The service will be kept under review and will be inspected within 12 months to ensure improvements are sustained.

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

Spring Street Surgery was previously inspected in November 2014 and August 2015 and was rated good overall and in all domains.

At this inspection in July 2018 the practice is rated as Inadequate

overall.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Spring Street Surgery on 18 July 2018 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.

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. Recruitment procedures did not ensure the necessary documentation was on file and we found gaps in recruitment documentation for the GP locum. There were no GP locum induction packs. Some Patient Group Directions (PGD) were out of date. (PGDs allow healthcare professionals to supply and administer specified medicines to pre-defined groups of patients, without a prescription).
• The management of significant events and patient and medicine safety alerts needed improvement.
• Policies and procedures did not always contain adequate, or practice specific information, some had not be reviewed for a number of years and information was not easy to locate.
• Some data relating to the management of long term conditions was significantly lower than clinical commissioning group (CCG) and England averages. We also noted that in some areas there was a higher number of patients who were exception reported. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
• Staff had not completed mandatory training including safeguarding vulnerable adults and children and most non-clinical staff had not received an appraisal.
• Not all staff were aware who the leads were for safeguarding and the practice policy and procedures did not contain adequate information.
• The practice acted on external information about patients experiences.
• Staff 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.
• 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:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure patients are protected from abuse and improper treatment.
• 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 ways to increase uptake for cervical screening.
• Review meeting structures for non-clinical staff and the frequency of attendance of clinical staff to ensure greater shared learning.
• Consider different ways to gather patient feedback.
• Review how information is displayed for patients who wish to make a complaint.

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 FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Spring Street Surgery on 18 November 2014.

Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, caring, effective, and responsive services. It was also good for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia). It required improvement for providing safe services.

Our key findings were as follows:

• There were a range of appointments to suit most patient’s needs
• Patients reported good access to the practice and a named GP or GP of choice, with urgent appointments available the same day.
• The practice engaged effectively with other services and agencies to ensure continuity of care for patients.
• Patient feedback showed that patients held the practice in high regard. They were involved in making decisions about their care and were treated with kindness and respect.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure there are clear arrangements in place for the management of out of date medicines.

The provider should:

• Ensure that patient information is clearly displayed for requesting chaperones
• Ensure staff are supported to participate in training and development according to their job roles

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 of this practice on 18 November 2014. Breaches of legal requirements were found during that inspection within the safe domain. After the comprehensive inspection, the practice sent an action plan detailing what they would do to meet the legal requirements in relation to the following:

• Ensure there are clear arrangements in place for the management of out of date medicines.

Our previous report also highlighted areas where the practice should improve:-

• Ensure that patient information is clearly displayed for requesting chaperones

We undertook this focused inspection on 10 August 2015 to check that the provider had implemented their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

Our key findings across the areas we inspected for this focused inspection were as follows:-

• All medicines reviewed were in date and the practice had clear protocols to check medicines were within their expiry date and suitable for use.
• Out of date medicines were disposed of in accordance with legislation requirements.
• Chaperone posters were present in the patients waiting area and in the GP surgeries.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice