We carried out an announced comprehensive inspection at Stable Fold Surgery on 17 December 2018 as part of our inspection programme. At the last inspection in December 2014 we rated the practice as good in all domains.

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:

• Some staff were not clear on the procedure for chaperoning patients. We were told that on occasions the GP requested that the chaperone stood outside the curtain.
• There was no process to check previous employment dates or the reasons for leaving for appropriate staff.
• Fire training for staff was out of date and there had been no formal fire drill.
• There was no evidence that the infection control lead had appropriate training. Infection control procedures, such as for hand washing, were not followed.
• Significant events were not well-managed. Significant event forms were not updated to include any investigation, discussion, learning or review. Information was instead recorded in various meeting minutes.

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

• Training was not up to date, so the practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.
• Although the practice participated in some local and national schemes they were unable to show evidence of improvement following clinical audits.
• Although there was evidence that the practice manager was well-supported, they had never had a formal appraisal.

We rated the practice as good for providing caring services because:

• The practice was knowledgeable about registering patients living in vulnerable circumstances, including those without an address.
• The practice knew how to respond to changes in patients’ preferred gender, name or title.
• The practice had completed Pride in Practice gold level.

We rated the practice as good for providing responsive services because:

• The practice opened until 8.30pm one evening a week and further late and weekend appointments were available at a nearby hub.
• Patients told us appointments were easy to access and they could receive on the day advice in an emergency.
• Although complaints were investigated and appropriately responded to there was no system to track their progress and use them to drive improvement.

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

• There was some evidence of risk assessment but there were gaps in fire safety, infection control and emergency medicines. The policies were not always followed.
• There was little evidence of systems and processes for learning and continuous improvement.
• Clinical audits did not demonstrate an effective approach to quality improvement.
• There was no evidence of formal support and assessment of staff.

These areas where improvements were required affected all population groups so we rated all population groups as requires improvement.

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.

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

The areas where the provider should make improvements are:

• Have a failsafe system to check all cervical screening results are received by the practice.
• Review patient group directions (PGDs) to check they are dated.
• Make sure staff are aware of procedures such as chaperoning and how to deal with uncollected prescriptions.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Stable Fold Surgery was inspected on the 9 December 2014. This was a comprehensive inspection. We rated the practice overall as good. We rated Stable Fold Surgery as good in relation to being safe, effective, caring, responsive and well-led.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
• People’s needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• 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 their GP and that there was continuity of care, with urgent appointments 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 proactively sought feedback from staff and patients, which it acted on.

We saw areas of outstanding practice for example:

• Use of “Chat Clinics” to encourage patients reluctant to undertake some screening test.

There were areas of practice where the provider needs to make improvements and the provider should:

• Ensure recruitment arrangements include all necessary employment checks for all staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice