We carried out an announced comprehensive inspection at Swanwood Partnership on 11 March 2019 as part of our inspection programme.

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 previously carried out an announced comprehensive inspection on 16 March 2018. At that inspection the practice was rated requires improvement overall and for all their population groups. The practice was rated as requires improvement for providing safe and well-led services and rated as good for providing effective, caring and responsive services. The practice was issued a requirement notice in regulation 17, good governance, to ensure the systems and processes to assess, monitor and improve the quality of services were improved.

What we found at our inspection in March 2018:

• There was not an effective system to manage infection prevention and control.
• Not all risks at the premises were assessed and managed. It was unclear who had oversight and responsibility so risks were not effectively mitigated.
• Not all patient group directions (PGDs) had been correctly completed and one had been incorrectly used to authorise a healthcare assistant to administer the shingles vaccination.
• The systems for managing and storing emergency medicines and equipment required improvement.
• There was not an effective, coordinated plan to improve QOF achievement in relation to blood pressure checks for patients with diabetes and hypertension.
• The practice manager had not received an appraisal in the last year.
• Systems to manage healthcare waste did not mitigate risks to patients and others.

At this inspection, we have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• There was an effective system to manage infection prevention and control.
• All risks at the premises were assessed and managed. It was clear who had oversight and responsibility so risks were effectively mitigated.
• Patient group directions (PGDs) had been correctly completed and updated.
• The systems for managing and storing emergency medicines and equipment had improved.
• The practice had a plan to improve QOF achievement in relation to blood pressure checks for patients with diabetes and hypertension. Unverified data we reviewed showed the practice had improved the monitoring for patients with diabetes and hypertension.
• All staff had received an annual appraisal.
• Systems to manage healthcare waste mitigated risks to patients and others.
• 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.
• The practice had identified 150 patients as carers which amounted to 2.1% of their practice population.
• The practice received 31 CQC comment cards regarding the care and treatment they had provided patients, 29 of which were positive.
• The practice had reviewed and learned from significant events and complaints however we found the practice had not effectively disseminated the learning to all members of staff.
• The practice had a process for ensuring the security of blank prescriptions however we found that the practice had not considered all aspects of monitoring. Since the inspection the practice had amended their security policy to ensure blank prescriptions were secure at all times.

The areas where the provider should make improvements are:

• Improve the dissemination of lessons learnt for significant events and complaints for all staff.
• Strengthen procedures to ensure effective prescription security.

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

This practice is rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires Improvement

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 – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

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

We carried out an announced comprehensive inspection at Swanwood Partnership also known as Applewood Surgery on 16 March 2018. This was carried out as part of our inspection programme.

At this inspection we found:

• The practice had systems to keep patients safe and safeguarded from abuse.
• There was not an effective system to manage infection prevention and control.
• Not all risks at the premises were assessed and managed. It was unclear who had oversight and responsibility so risks were not effectively mitigated.
• Not all patient group directions (PGDs) had been correctly completed and one had been incorrectly used to authorise a healthcare assistant to administer the shingles vaccination. We were sent in evidence and assurances after the inspection that these issues had been addressed.

• Immediately after our inspection, the practice provided evidence of the improvements made to the storage of emergency medicines and equipment.

• The practice had an effective system of monitoring and tracking referrals once these had been made.
• There was not an effective, coordinated plan to improve QOF achievement in relation to blood pressure checks for patients with diabetes and hypertension.
• The practice had systems to monitor and review patients over 75. There had been 38 health checks for patients aged over 75 completed in the last 12 months.
• The practice manager had not received an appraisal in the last year. We were assured that this took place immediately following our inspection.
• As a teaching practice, there was a weekly meeting with trainee GPs and doctors to discuss any issues and provide mentoring.
• Interpretation services were available for patients who did not have English as a first language. Languages other than English were spoken by clinicians.
• The practice offered extended opening hours and would be partaking in the Prime Ministers’ Challenge Fund from April 2018. This was to provide additional GP services in the evenings and on weekends, working with other GPs in the locality.
• The practice was responsive to patient concerns about access and in response to this had recruited a nurse practitioner to see patients with minor illnesses, made changes to the appointment system, introduced telephone consultations and increased the number of telephone lines.
• Leaders had the skills to deliver high-quality care, although some risks had been overlooked as the practice managed its increasing list size.

The areas where the provider must make improvements are:

• 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:

• Continue to review and improve feedback from the GP patient survey.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice