We carried out an announced comprehensive inspection at The Rose Tree PMS Practice on 5 February 2019 as part of our inspection programme. Our last inspection of the Rose Tree PMS Practice was in December 2014 and the practice was rated as Good.

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 inadequate overall.

We rated the practice as

inadequate

for providing safe services because:

• The practice did not have clear systems and processes to keep patients safe. Not all staff had received the appropriate level of safeguarding training.
• The recruitment policy had not been fully implemented and not all the required checks had been undertaken.
• Health and safety checks had not been completed for all areas within the practice remit and staff had not had all the required training in health and safety matters such as fire safety and infection prevention and control.
• Provision of emergency medicines was not based on risk assessment. Not all staff were aware of the emergency equipment and medicines provided and how to access these or training in basic life support.

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

• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.
• Some performance data was significantly below local and national averages.

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

• Data showed low patient satisfaction with the service in some areas, although on the day of the inspection we found good levels of patient satisfaction. However, the practice had not undertaken any patient surveys to review and improve patient satisfaction following the national GP survey.

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

• Data showed low patient satisfaction with the service in some areas although on the day of the inspection we found good levels of patient satisfaction. However, the practice had not undertaken any patient surveys to review and improve patient satisfaction following  the national GP survey.

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

• While the practice had a clear vision, and a credible strategy staff had not always been involved.
• The overall governance arrangements were not always effective. Policies and procedures were not always accessible to staff.
• The practice did not have clear and effective processes for managing risks and to improve the quality and safety of the services being provided.

These areas 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.

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed. Ensure specified information is available regarding each person employed. Ensure, where appropriate, persons employed are registered with the relevant professional body.

• 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:

• Review and establish tenant responsibilities, if any, in regard to the health and safety risk assessments undertaken by the landlords of each site.
• Consider the use of a clinical tool to identify older patients who are living with moderate or severe frailty.
• Review and improve how information about the practice is shared with the patient participation group.

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 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.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced inspection visit on 10 December 2014 and the overall rating for the practice was good. The inspection team found after analysing all of the evidence the practice was safe, effective, caring, responsive and well led. It was also rated as good for providing services for all population groups.

Our key findings were as follows:

• The practice learned from significant events and incidents and took action to prevent their recurrence.

• Patients received care according to professional best practice clinical guidelines. The practice had regular information updates, which informed staff about new guidance to ensure they were up to date with best practice.

• Patients said staff were caring and respectful; they were involved in their care and decisions about their treatment.

• The service was responsive and ensured patients received accessible, individual care, whilst respecting their needs and wishes.

• There were positive working relationships between staff and other healthcare professionals involved in the delivery of service.

However, we also found an area in which an improvement was needed:

• The practice did not have a patient participation group (PPG).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with the practice manager, three doctors, other staff members and patients who were waiting to see the doctor or nurse on the day of our inspection.

Patients told us they were treated with respect, one person said “I have no problem seeing any of the GPs, they all treat you with respect and are very friendly.” They said their views about their care and treatment were listened to and it met their needs. Mostly patients told us they did not have to wait too long for appointments and that they were always welcomed in a friendly manner.

Patients said they felt really at ease with all of the GPs, one said “I really trust them.” We found that patients were protected from the risk of abuse.

We saw that there were effective systems in place to reduce the risk and spread of infection. All areas of the practice were clean and welcoming.

Staff told us that they were supported by the doctors and other team members and that they were positively encouraged to complete their Continuing Professional Development (CPD).

Patients told us that they had not had any need to complain; but if necessary they would speak either to the doctor or the practice manager.