We carried out an announced comprehensive inspection at Summerfield Primary Care Centre also known as Dr Kulshrestha's Summerfield Family Practice on 13 February 2019 as part of our inspection programme.

At the last inspection in February 2018 we rated the practice as requires improvement for providing safe, effective and caring services. We rated the service inadequate for providing well-led services.

We based our judgement of the quality of care at this service is 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:

• Most risks were managed to ensure patients were kept 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 opening hours were limited however feedback from patients regarding access was positive and comparable to local and national averages.
• The practice had implemented changes to governance processes to manage risks and promote the delivery of high-quality, person-centre care.

The areas where the provider should make improvements are:

• Review process to ensure more carers are identified.
• Review approach for cancer screening such as cervical cytology so further improvements could be achieved.

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

We carried out an announced comprehensive inspection at Summerfield Family Practice on 11 August 2016. The overall rating for the practice was Requires Improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the “all reports” link for Summerfield family practice on our website at www.cqc.org.uk

This inspection was a comprehensive inspection carried out on 28th February 2018 to confirm that the practice had carried out their plan to meet legal requirements in relation to the breaches in regulations that we identified in our previous inspection in August 2016. This report covers our findings in relation to those requirements and also additional improvements identified. The practice is now rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Requires Improvement

Are services responsive? – Good

Are services well-led? – Inadequate.

At this inspection we found;

• The premises were clean and tidy and staff were aware of infection control procedures. However, the infection control audit completed by the practice was not effective as it did not assess or identify all areas where action was required.

• We looked at training records for staff and found that, in some areas, training appropriate to their role had not been completed. For example, some members of the clinical staff had not undertaken safeguarding vulnerable adults training, Mental Capacity Act training and immunisation updates.

• The national GP patient survey data was generally good; however responses relating to nursing services were less positive. The practice had not reviewed this feedback in order to identify areas for further improvement.

• Patients we spoke to on the day said they were generally happy with the practice and the staff, many of whom had been with the practice a long time

• The practice performance demonstrated that outcomes for patients were in line with CCG and national averages.

• Some of the governance arrangements within the practice were effective and supported the safe delivery of care. However there were areas where systems and processes lacked oversight in order to minimise risks to patients; for example, the monitoring of Patient Group Directions and the oversight of training.

• There was little evidence of effective systems around monitoring staff competencies.We saw examples of non-clinical staff updating clinical records on behalf of clinicians; however, there was no clinical oversight of this.

• The practice had addressed some but not all of the issues identified in the previous report and further issues had been identified around governance in this inspection.

• The practice did not have a system to make use of opportunites for learning from incidents and complaints such as failing to analysie the overall trends and develop actions plans around these.

• The practice did not make all reasonable adjustments to ensure access to vulnerable patients.

• Reported rates for cancer screening and childhood immunisations were low in comparison to local and national averages.

The areas where the provider MUST make improvements are:

• Ensure that 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 improvements are:

• Consider ways to further improve patient engagement in respect of immunisations and cervical cytology.

• Take a proactive approach to supporting carers, identified on the carers register.

• Ensure all staff are aware of the process for registering patients who are homeless.

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 Summerfield Primary Care Centre on 11 August 2016. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. There was evidence of learning from most individual incidents. However there had been no analysis of incidents to identify emerging trends.
• Risks to patients were not always well managed, for example those relating to recruitment checks and medicines management.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. However, this was done informally and no systematic approach was in place.
• Data showed patient outcomes were slightly below local and national average.
• Audits were carried out and we saw evidence that they were driving improvements to patient outcomes.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. Data we looked at confirmed this.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a number of policies and procedures to govern activity, but some were overdue a review and others needed to be personalised to the practice and embedded.
• There was a leadership structure but staff were not always clear of lead roles.

The areas where the provider must make improvements are:

• The practice must ensure the proper and safe management of medicines and vaccines.
• The practice must ensure that appropriate recruitment arrangements are in place.
• Governance processes must be effective in identifying, monitoring and managing risks within the practice. An effective process must be in place to ensure appropriate receipt, action and monitoring of patient safety alerts. Recorded incidents should be analysed for themes and trends.

In addition the provider should:

• Systems or processes should be reviewed to ensure carers are identified so they can be offered appropriate support.
• Effective processes should be in place to ensure improvement in uptake for the cervical cytology screening.
• A systematic approach to respond and action NICE and other relevant guidelines should be developed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice