This practice is rated as Good overall. (Previous inspection 11 July 2017 – the practice was rated as Requires improvement.)

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 Sternhall Lane Surgery on 9 August 2016. The overall rating for the practice was requires improvement. As a result of our findings from this inspection CQC issued a requirement notice for the identified breaches of Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We carried out a further announced comprehensive inspection on 11 July 2017 to follow up on the breaches of regulations and areas of improvement identified. While most of the issues leading to the breaches in August 2016 had been resolved, further concerns were identified in relation to infection control, medicines management and governance systems. Overall the practice remained rated as requires improvement and CQC issued a requirement notice for the breach of Regulation 17 and a warning notice for the breach of regulation 12.

The full comprehensive reports for the previous inspections in 2016 and 2017 can be found by selecting the ‘all reports’ link for Sternhall Lane Surgery on our website at www.cqc.org.uk.

This inspection was undertaken within six months of the publication of the last inspection as the practice was rated as inadequate for one of the key questions; are services safe? This inspection was an announced comprehensive inspection on 14 March 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was to follow up on the breaches of regulations 12 and 17 and areas of improvement identified from the last inspection, in line with our next phase inspection programme.

At this inspection we found:

• The practice had clear and improved 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.

• The practice had improved the management of prescriptions and results so they were safe.

• 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.

• The practice had implemented a number of systems to ensure that staff had the skills and knowledge to provide effective care.

• 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.

• Complaints were investigated and responded to openly and thoroughly and information about how to make a complaint was easily accessible for patients.

• There was a positive and open culture and staff felt supported by the practice leaders; systems for cascading information to staff had improved.

• 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 engage with the premises owner regarding premises improvements.

• Work to increase the uptake of breast and bowel screening and improve child immunisations in areas that are below the national target.

• Review how the Patient Participation Group can be used to improve the service delivered.

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 Sternhall Lane Surgery on 9 August 2016. The overall rating for the practice was requires improvement. The full comprehensive report from the inspection undertaken on 9 August 2016 can be found by selecting the ‘all reports’ link for Sternhall Lane Surgery on our website at www.cqc.org.uk.

As a result of our findings from this inspection CQC issued a requirement notice for the identified breaches of Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Specifically we found concerns related to the management of emergencies, sufficient numbers of permanent clinical and administrative staff, training that had not been completed and the lack of action taken to mitigate risks identified.

This inspection was undertaken within 12 months from the last inspection as the practice was rated as requires improvement for two of the key questions; are services safe? and are services well led? This was an announced comprehensive inspection completed on 11 July 2017. While (most of) the issues leading to the breaches in 2016 had been resolved, overall the practice remains rated as requires improvement.

Our key findings at this inspection were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However there was limited evidence of learning from significant events and not all staff were aware of how to report a significant event or involved in discussions.
• Although the practice had systems in place to minimise risks to patients stemming from equipment we found that prescriptions were not being managed safely. There had been no infection control audit undertaken within the last 12 months, fire drills were not recorded and we found an expired paediatric mask with the practice’s oxygen supply.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However not all staff had received the level of safeguarding training as specified in their safeguarding policy, GPs working at the practice had not received an internal appraisal and clinical updates were not being discussed regularly in clinical meetings.
• Performance against national clinical targets was comparable to local and national performance. However the practice had not undertaken any analysis of higher rates of exception reporting to ensure that their decision to exclude patients from assessments was clinically justified. We also found that the bowel and breast screening rates were below local and national averages and that the practice was below the national target for the delivery of one child immunisation. Only four of the practice’s 23 patients with learning disabilities had received an annual healthcheck in the last 12 months.
• 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.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. However we found that complaints responses were not always recorded and responses did not contain information about how patients could escalate complaints if they were dissatisfied with the practice’s response.
• Some patients we spoke with said they found it difficult to make an appointment with a named GP which impacted on continuity of care. The practice had recently recruited new salaried staff members in an effort to reduce the practice’s reliance on locums. 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement 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

The areas where the provider should make improvement are:

• Consider ways to increase the number of patients with learning disabilities who receive an annual health review.

• Continue to engage with the premises owner regarding premises improvements.

• Work to increase the uptake of breast and bowel screening and improve child immunisations in areas that are below the national target.

• Review and risk assess frequency of infection control training for non clinical staff

• Improve systems to monitor the expiry date of emergency medical equipment.

• Discuss clinical updates in practice meetings.

• Consider a system of internal appraisal for salaried GP staff.

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 Sternhall Lane Surgery on 9 August 2016. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and systems in place for reporting and recording significant events. However learning from some events was not clear or shared effectively.
• Some risks to patients were assessed and well managed though the practice had not complied with the recommendations in their fire and legionella risk assessment and the infection control issues identified in their latest infection control audits had not all been acted upon.
• 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. However, the practice employed GP locums for 13 of the 22 sessions offered to GP practice patients. Staff told us that this impacted on continuity of care and that there was a high administrative burden for the two of the permanent GPs as a result of lack of adequate permanent staff.
• 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 though responses did not contain information of external agencies patients could contact if they were dissatisfied with the practice’s response.
• As a result of the lack of permanent staffing, patients said they did not find it easy to make an appointment with a named GP and there was a lack of continuity of care. The practice did offer urgent same day appointments.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour; though the practice did not keep records of action taken in response to patient safety alerts.

The areas where the provider must make improvement are:

• Ensure that all staff complete role appropriate training in accordance with current guidelines.

• Review practice emergency arrangement to ensure that all equipment is in date and regularly serviced.

• Ensure that action is taken to mitigate risks associated with fire, infection control and legionella.

• Ensure that

  systems and processes used to manage significant events and patient safety alerts operate effectively; recording action taken in response to patient safety alerts and involving all staff in discussion and learning from significant events.

• Ensure that there are sufficient numbers of staff to provide patients with continuity of care and reduce the administrative burden on existing permanent clinical staff.

The areas where the provider should make improvement are:

• Improve the mechanisms for identifying those patients with caring responsibilities. Review QOF domains where exception reporting is high and consider strategies to improve patient outcomes by reducing exception reporting in these areas.

• Advertise translation services in the practice waiting area.

• Review vaccine monitoring failsafe systems.

• Ensure that appropriate information regarding the recruitment of staff is retained.

• Consider a system of internal appraisal for salaried GP staff.

• Consider drafting a practice specific business plan which is regularly reviewed monitored and updated.

• Hold regular clinical meetings and document minutes from all multidisciplinary meetings.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice