This practice is rated as Good overall. We previously carried out an announced comprehensive inspection at St Mary’s Surgery in December 2016 and rated the practice as Good overall with requires improvement for the population group people whose circumstances may make them vulnerable. The practice had displayed their ratings in a prominent place within the surgery.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at St Mary’s Surgery on 13 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice had worked to improve the support offered to people with a learning disability. The number of health reviews offered to people with a learning disability had significantly increased.

• The practice was above average for its satisfaction scores on consultations with GPs and nurses. Results from the national GP patient survey also showed patients responded positively to questions about their involvement in planning and making decisions about their care and treatment. Results were higher than local and national averages.

• 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.

• There were clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

• 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 had the skills, knowledge and experience to carry out their roles.

• 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.

• 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:

• Continue to develop the carers register to further identify patients who are carers and may need support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We first inspected St. Mary’s Surgery on 24 February 2016 as part of our comprehensive inspection programme. The practice was rated as inadequate and was placed into special measures. You can read the report from our last comprehensive inspection; by selecting the 'all reports' link for St Mary's Surgery on our website at www.cqc.org.uk. During the inspection in February 2016 we found the practice was in breach of a number of regulations. The breaches related to appropriate processes were not in place to mitigate risks in relation to the safety and quality of the services offered. This included health and safety risk assessments, the use of clinical audit to improve patient outcomes, reviewing and acting on patient safety alerts. The practice did not demonstrate that they had considered the availability of emergency medicines in order respond to emergencies.

Following the inspection the practice wrote to us to say what they would do to meet the regulations. We undertook this inspection on 13 December 2016 to check that they had followed their plan and to confirm that they had met the legal requirements. Overall we found improvements had been made and the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• Effective recruitment procedures had been implemented since the comprehensive inspection in February 2016. This included Disclosure and Barring (DBS) checks for staff who required them.
• Patients we spoke with on the day of the inspection were positive about the staff. We saw that staff were friendly and helpful and treated patients with kindness and respect.
• The practice had introduced a programme of audits that were driving improvement in patient outcomes.
• The management team had introduced team meetings on a monthly basis and clinical staff meetings every two weeks which were minuted to ensure all staff were kept up to date.
• The practice had introduced formal governance arrangements to assess and manage risks and monitor the quality of the service provided. We saw a range of comprehensive risk assessments were in place such as health and safety, fire and infection control. There were adequate arrangements in place to respond to medical emergencies.
• A system had been implemented to ensure all patient safety alerts including alerts received from the Medicines Health Regulatory Authority (MHRA) alerts were reviewed, actioned and discussed with the practice team at clinical and staff meetings.
• We saw that following our comprehensive inspection in February 2016, the practice had carried out an audit to ensure patient’s records were coded appropriately and being utilised and updated regularly.
• The practice had implemented the use of nationally recognised guidance, including guidelines issued by NICE (National Institute for Health and Care Excellence).
• There were clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The provider was aware of and complied with the requirements of the duty of candour.
• There was a clear leadership structure and staff felt they were supported by the practice manager and GPs. The practice had set up a patient participation group (PPG), which was in its infancy; there was evidence that the group was committed to working with the practice to improve the service.

There are areas where the provider should make improvements:

• Continue to review the carers register to identify patients who are carers and may need support.
• Review the referral process to ensure comprehensive information includes the patient’s history, current medicines and the reason for referral.
• Encourage a greater proportion of patients with a learning disability to receive an annual health check.
• Review current processes for the recording of staff immunisation status to ensure records are kept up to date.
• Review options to notify landlords of work that is required to ensure completion of actions identified.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

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 St. Mary’s Surgery on 24 February 2016. Overall the practice is rated as inadequate.

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

• Staff assessed patients’ needs but did not have effective procedures in place to ensure care and treatment was delivered in line with current evidence based guidance.
• The practice did not have a Patient Participation Group in place and on speaking with patients there was no evidence that feedback had been sought from them in the past.
• Some audits had been carried out however we saw no evidence that audits were driving improvement in performance to improve patient outcomes.

• There was no evidence that medicine safety alerts were actioned appropriately.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• 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.

• Information about services and how to complain was available and easy to understand.
• There was a system in place for reporting and recording significant events, action plans and lessons learnt were documented.
• Staff understood and fulfilled their responsibilities to raise safety concerns and to report incidents and near misses however it was unclear who the Safeguarding lead was.
• As tenants in the health centre, the provider had not assured themselves that risks to patients, visitors and staff had been appropriately assessed and managed.

There were also areas of practice where the provider needs to make improvements.

The provider must:

• Ensure appropriate assessment of needs are undertaken and an accurate and complete record is in place including the care and treatment provided and the decisions taken in relation to the care and treatment

• Ensure robust system is in place for receiving, reviewing and actioning all safety alerts to ensure that appropriate action is taken.

• Ensure appropriate processes to assess, monitor improvement and mitigate risks in relation to both the safety and quality of the service, for example the use of risk assessment and audit.

• Review and risk assess the emergency medicines to ensure appropriate supply.

The provider should:

• Identify carers and ensure support for this group of patients.

• Not detail information about complaints received in patient’s medical records

• Ensure that where lead roles have been allocated staff are fully aware, trained and supported for their role and responsibility.

• Review and implement processes for recording, for example safeguarding concerns and ensure checks of emergency equipment are maintained.

I am placing this service in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 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.

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