We carried out an announced comprehensive inspection at The Practice Bowling Green Street on 11 December 2018 as part of our inspection programme for new registrations.

The practice was taken over by DHU Health Care in February 2018.

We base 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 Inadequate overall.

We rated the practice as Inadequate for providing safe services because:

• The practice did not always have clear systems, practices and processes to keep people safe.
• There were some gaps in systems to assess, monitor and manage risks to patient safety.
• The practice did not have systems for the appropriate and safe use of medicines.
• The practice did not have a system to learn and make improvements when things went wrong.

We rated the practice as Requires Improvement for providing effective services because:

• Patients care and treatment was not always delivered in line with current standards.
• There was limited monitoring of the outcomes of care and treatment.
• The practice was unable to demonstrate that all staff had the skills, knowledge and experience to carry out their roles.

We rated the practice as Requires Improvement for providing caring services because:

• The practice did not carry out any patient feedback exercises.
• The practice did not have a system to support carers.

We rated the practice as Requires Improvement for providing responsive services because:

• People were not always able to access care and treatment in a timely way.
• Complaints were not used to improve the quality of care.

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

• The oversight and governance arrangements for the management and performance of the practice were ineffective.
• The practice had a clear vision but it was not supported by a credible strategy to provide high quality sustainable care.
• The practice did not always have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• There was little evidence of systems and processes for learning, continuous improvement and innovation.

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.

The practice received two warning notices which required them to be compliant with regulations by 31 March 2019. The practice also received a requirement notice regarding regulations which can be found at the end of the report.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of 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 to 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 by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

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

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice