We carried out an announced comprehensive inspection at The Thorndike Surgery on 27 and 28 June 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for The Thorndike Surgery on our website at www.cqc.org.uk.

After the inspection in June 2017 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

This inspection was an announced focussed inspection carried out on 6 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 27 and 28 June 2017. This report covers findings in relation to those requirements.

This practice is now rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Good

As part of our inspection process we also look at the quality of care for specific patient population groups. The patient population groups are rated as:

Older people – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) – Good

Our key findings were as follows:

• The practice followed national guidance on the management of medicines and infection prevention and control.

• Improvements to risk management had been made with health and safety risks now being assessed and well managed.

• Incoming records that required the attention of clinical staff were now being processed in a timely manner.

• The way the practice referred patients to other services had improved.

• Results from the national GP patient survey published in July 2017 demonstrated improvements in patient satisfaction scores on consultations with GPs and nurses as well as on their involvement in planning and making decisions about their care.

• Results from the national GP patient survey published in July 2017 also demonstrated a decline in all but one of the patient satisfaction scores with how they could access care and treatment at this practice.

• The availability of the different types of appointments offered by the practice had improved. However, further improvement in the availability of routine appointments was still required.

• Improvements to governance arrangements at the practice had taken place.

• Plans to address the safety issues associated with the shortage of clinical staff had been enhanced and implemented resulting in improvements.

• The practice was able to demonstrate that learning from complaints received was taking place with planned improvements being implemented more fully.

The areas where the provider must make improvements are:

• Continue to implement plans to improve patient satisfaction scores.
• Continue to implement plans to improve patient access to routine appointments.

The areas where the provider should make improvements are:

• Continue to work with the contracted external company to manage and reduce the risks associated with legionella. (Legionella a germ found in the environment which can contaminate water systems in buildings).
• Continue to manage all incoming records in a timely manner.

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 Thorndike Surgery on the 2 December 2014. During the inspection we gathered information from a variety of sources. For example, we spoke with patients, interviewed staff of all levels and checked that the right systems and processes were in place.

Overall the practice is rated as good. This is because we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for all patient population groups.

Our key findings were as follows:

• Patients’ said they felt safely cared for and had no concerns about their care or treatment.
• Staff were helpful, caring and considerate to patients’ needs.
• Patients felt listened to and their opinions about care and treatment were acted upon.
• The environment was safe and always cleaned to a high standard.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
• Patients said they were treated with dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about how to complain was available and easy to understand.
• The practice had a clear vision which had quality and safety as its top priority.
• A business plan was in place, was monitored and regularly reviewed and discussed with all staff.

However, there were also areas of practice where the provider should make improvements:

• Staff meetings that include attendance of the whole staff team.
• Ensure that clinical audits are complete audit cycles.
• Improve processes for making appointments and reducing waiting times.

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 Thorndike Surgery on 27 and 28 June 2017. Overall the practice is rated as requires improvement.

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

• There was an effective system for reporting and recording significant events.
• There were systems, processes and practices to help keep patients safe and safeguarded from abuse.
• The practice was unable to demonstrate they always followed national guidance on infection prevention and control.
• The arrangements for managing medicines in the practice did not always keep patients safe.
• Risks to patients, staff and visitors were not always assessed and managed in an effective and timely manner.
• The practice had arrangements to respond to emergencies and major incidents.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• There was evidence of clinical audits driving quality improvement.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice was unable to demonstrate they had an effective system that managed test results and other incoming correspondence in a timely manner.
• The practice was unable to demonstrate they had a reliable system that followed up on patients who were referred to other services.
• Patients said they were treated with compassion, dignity and respect. However, national GP patient survey results were poor for some satisfaction scores on consultations with GPs and nurses and for involvement in planning and making decisions about their care and treatment when seeing nurses.
• There was limited access to routine appointments for patients, which was ongoing.
• Information about services and how to complain was available and easy to understand. Some improvements were made to the quality of care as a result of complaints and concerns.
• Governance arrangements were not always effectively implemented.
• There was a clear leadership structure and most staff felt supported by management. The practice gathered feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements 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;

• Include all clinical equipment in checking to help ensure it is working properly.

• Ensure all staff receive an annual appraisal.

• Continue to identify patients who are also carers to help ensure eligible patients are offered relevant support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice