We carried out an announced comprehensive inspection at Ware Road Surgery on 13 December 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 requires improvement overall.

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

• The practice did not have clear and effective processes for managing risks, issues and performance in some areas.
• Some receptionists had not been given guidance on identifying deteriorating or acutely unwell patients.
• The practice did not have appropriate systems in place for the safe management of emergency medicines.

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

• The practice was unable to show that all staff members had the training to carry out their roles effectively.
• The practice was unable to demonstrate how personal development plans were periodically monitored and reviewed for all staff members.
• The practice did not have a formal system in place to ensure clinicians were up-to-date with the latest clinical guidelines.

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

• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.

These areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as good for providing caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

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.

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

The areas where the provider should make improvements are:

• Continue to identify and support carers.
• Review the process in place to ensure all relevant staff members are aware of risks to deteriorating or acutely unwell patients.
• Continue to monitor the protocols in place for the safe management of clinical waste.

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