We previously carried out an announced comprehensive inspection of The Summitt Practice on 4 January 2019 and found that the practice was in breach of Regulation 12: ‘Safe care and treatment’ and Regulation 17 ‘Good governance’ of the Health and Social Care Act 2008. In line with the Care Quality Commission’s (CQC) enforcement processes, we issued warning notices which required The Summitt Practice to comply with the Regulations by 29 March 2019. The full report of the 4 January 2019 inspection can be found by selecting the ‘all reports’ link for The Summitt Practice on our website www.cqc.org.uk.

We carried out this announced focused inspection on 9 May 2019 to check whether the practice had addressed the issues in the warning notice and now met the legal requirements. This report covers our findings in relation to those requirements and will not change the current ratings held by the practice.

At the inspection on 9 May 2019 we found the provider had acted to address all the requirements of the Regulation 12 warning notice and most of the Regulation 17 warning notice.

Our key findings were as follows:

• Emergency medicines and equipment were fit for use and related checks were implemented.
• Significant events and safety alerts were identified, documented and followed up.
• Risk assessments for fire and premises safety had been carried out, but the provider was not assured the frameworks were suitable .
• There was an effective induction system for temporary staff tailored to their role.
• The practice had systems for the appropriate and safe use of medicines.
• Staff had the information they needed to deliver safe care and treatment.
• The practice had a vision, but it was not supported by a credible strategy or action plans to underpin high quality sustainable care.
• Processes for managing risks, issues and performance had been implemented but their effectiveness was not assured.

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.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and evidence table for further information.

We carried out an announced comprehensive inspection at The Summitt Practice on 4 January 2019.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 16 November 2017 when the practice was rated as requires improvement for safety, caring, being well-led, and overall.

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 including because:

• There were gaps in staff recruitment processes and checks.
• There were weaknesses and shortfalls in health and safety arrangements including risk assessments in areas such as fire and premises, and Control of Substances Hazardous to Health (COSHH).
• Emergency medicines and equipment were not always provided or checked as fit for use. This issue was repeated after we highlighted it at our previous inspection on 16 November 2017.
• There was no failsafe system to ensure results sent for the cervical screening program were received or missing results follow up. A search showed there were 25 cervical screening samples taken between 2016 and 2018 where no results were received, and the practice had not acted to address this.
• There was insufficient identification, documentation, and management of significant events to improve safety.
• Patient Group Directions (PGDs) were not properly signed and authorised. (PGDs are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment).

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

• Leaders had not addressed several of the risks and concerns we identified at our previous inspection 16 November 2017.
• The practice did not always hold or act on appropriate and accurate information.

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

• The practice had not accurately identified patients that are carers to ensure appropriate support could be provided to them. This issue was repeated after we highlighted it our previous inspection on 16 November 2017.
• The practice GP Patient survey data relating to caring services was slightly but consistently lower than average and there was no evidence of action taken to improve, although one of the indicators had improved. This issue was repeated after we highlighted it our previous inspection on 16 November 2017.

We rated the practice as Good for providing effective services because:

• Some cancer performance data was lower than average, but patients otherwise received effective care and treatment that met their needs.
• Patient’s care and treatment was delivered in line with current legislation, standards and evidence-based guidance.

We rated the practice as Good for providing responsive services because:

• The practice organised and delivered services to meet patients’ needs.
• Complaints were listened and responded to and used to improve the quality of care.

These areas affected all population groups, so we rated all population groups as Good.

The areas the provider must improve:

• 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.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed and specified information is available regarding each person employed.

The areas the provider should improve:

• Continue to work to improve the uptake of childhood immunisation rates.

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.

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

Letter from the Chief Inspector of General Practice

This practice is rated as requires improvement overall. (Previous inspection 06 2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Requires improvement

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 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 The Summit Practice on 16 November 2017 as a part of our inspection programme.

At this inspection we found:

• The practice had limited systems to monitor the effectiveness of processes such as infection control, we found that the nurse’s room was visibly dirty and there was a full sharps bin left on the floor.

• The processes for monitoring and managing emergency medicines and equipment were not effective, there was no delivery system for the oxygen and the supply of emergency medicines included the wrong adrenaline. This was addressed by the end of the inspection.

• Data from the national GP patient survey showed the practice was mostly rated below the national averages for all aspects of care. The practice had begun to work on ways to improve this.

• Clinical audits demonstrated quality improvement.

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• The practice did not routinely review the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence- based guidelines.

• The practice held regular meetings where all staff members were invited and practice achievements and targets were discussed.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• The practice worked closely with the patient participation group (PPG) and had a weekly health walk in a local park with them.

The areas where the provider must make improvements as they are in breach of regulations 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 improvements are:

• Continue to work to improve patient satisfaction with services provided.

• Continue to work to improve the uptake of childhood immunisation rates and bowel screening.

• Continue to work to identify patient carers and provide appropriate care to them.

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 the Summitt Practice on 3 June 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to be good for providing well-led, caring, and responsive services. We found the practice to require improvement for providing a safe and effective service. It also required improvement for providing services for the care provided to older people, people with long term conditions and for people experiencing poor mental health (including people with dementia)., families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable.

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. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• 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.

However, there were areas of practice where the provider needs to make improvements.

Importantly the provider must:

• Ensure all nonclinical staff acting as chaperones have a Disclosure and Barring Service (DBS) check or have risk assessments in place.
• Ensure all equipment is calibrated.
• Ensure appraisals of the nursing staff are undertaken.

The provider should:

• Ensure all out of date medical equipment is disposed of, including out of date swabs and syringes.
• Ensure all diabetic reviews are undertaken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice