We carried out an announced comprehensive inspection at Upton Road Surgery on 12 December 2018. We gave the practice 48 hours notice of the inspection. We carried out this inspection due to concerns which had come into the Commission from a number of different sources.

We had previously inspected the practice on 24 August 2016 and had rated the practice as ‘Good’. Since our last inspection some significant changes had taken place at the practice which included the practice taking over a substance misuse service. This had happened at short notice for the practice and had been in place at the practice since 1 October 2018.

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.
• Staff were not being safely recruited.
• The practice did not have appropriate systems in place for the safe management of medicines.
• The practice did not learn and make improvements when things went wrong.
• The premises were not safe and suitable for staff, patients and visitors to use.

We rated the practice as requires improvement for providing effective, caring and responsive services because:

• Improvement was needed in how staff were developed and supported at the practice.
• Consent was not being sought appropriately or in line with legal requirements.
• The practice had not responded to the care and treatment needs of people who resided in a care home which had been aligned to the practice. These patients had not been treated with dignity or respect.
• There was limited evidence in relation to how patients could feedback on how the practice was run.
• The practice had not made the changes it needed to in order to respond to the needs of the additional substance misuse service it had recently taken over.

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

• There was no clear governance structure in place at the practice. Roles and responsibilities were not clearly defined.
• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
• The practice lacked a clear vision and there was no credible strategy in place.
• The practice culture did not effectively support high quality sustainable care.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• We saw 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.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

• Improve the uptake of patients for the national cancer screening programme.
• Improve the monitoring and review of patients suffering with diabetes, as highlighted in the Quality and Outcomes Framework data for 2017/18.

(Please see the specific details on action required at the end of this 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 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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Upton Road Surgery on 24 August 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The patients we spoke with or who left comments for us were positive about the standard of care they received and about staff behaviours. They said staff were professional, polite, caring and friendly. They told us that their privacy and dignity was respected and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Some patients said it could be difficult to book appointments in advance. However, they were positive about access to same day and urgent appointments at the practice.
• 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. The practice sought feedback from staff and patients, which it acted on.
• The provider complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Ensure that all staff employed are supported by receiving appropriate supervision and appraisal and are completing the essential training relevant to their roles, including infection prevention and control training.
• Ensure that a process is in place for the practice wide discussion on and response to Medicines and Healthcare products Regulatory Agency (MHRA) and patient safety alerts.
• Ensure that all staff are aware of who the infection control leads are and that the plan of action to control and resolve risks identified by the infection control audit is fully completed.
• Monitor the newly implemented process to ensure patients aged 16 years or under who do not attend hospital appointments are appropriately followed up.
• Ensure the practice adheres to all National Institute for Health and Care Excellence (NICE) best practice guidelines.
• Ensure that all decisions made and action taken in relation to the monitoring and review of patients prescribed higher risk medicines are recorded on the practice’s own patient record system.
• Continue to support carers in its patient population by providing annual health reviews.
• Ensure full details of doctors’ verbal communications with patients before obtaining consent for procedures carried out at the practice are recorded.
• Continue to take steps to ensure that in future National GP Patient Surveys the practice’s areas of below local and national average performance are improved, including access to appointments.
• Continue to engage with the Patient Participation Group and ensure that it maintains an active role in the delivery of the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice