This service is rated as good overall. (Previous inspection on 23 May 2018 – Inadequate)

The key questions are rated as:

Are services safe? – Good

Are services effective? – requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Wenlock Terrace Surgery on 23 May 2018 the overall rating for the service was inadequate.

This service was placed in special measures in July 2018. The full comprehensive report on the May 2018 inspection can be found by selecting the ‘all reports’ link for Wenlock Terrace Surgery on our website at .

A further focussed inspection was undertaken in September 2018, where we followed up concerns from the two warning notices and condition on registration we had issued.

That re-inspection was not given a rating but we were satisfied that risks had been sufficiently reduced at that time. This inspection was an announced comprehensive inspection carried out on 8 January 2019 to confirm that the service had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspections.

Overall the service is now rated as good overall, and requires improvement for effective service. We rated the population groups of older people, children, families and young people, working age people (including those recently retired and students) and people experiencing poor mental health as requires improvement, people with long term conditions as inadequate and people whose circumstances make them vulnerable as good.

Our key findings were as follows:

• The provider encouraged reporting of incidents. This had increased the effectiveness of reporting, lessons learned and feedback to staff
• The practice had systems in place to manage risk so that safety incidents were less likely to happen.
• There was limited monitoring of the outcomes of care and treatment.
• Some performance data was significantly below local and national averages.
• There were arrangements in place to review the effectiveness and appropriateness of the care being provided.
• Arrangements for monitoring and reviewing prescribing helped ensure that patients were kept safe.
• Arrangements were in place to ensure that staff were working within the scope of their competency. Staff received appropriate support, training, professional development and appraisal as was necessary to carry out the duties they are employed to perform
• During our inspection we saw that staff treated patients with compassion, kindness and respect.
• Arrangements for the identification of carers and offer of support had improved.
• Patients and staff told us that making an appointment to see a clinician was easier but telephone access was still sometimes difficult.
• The practice had established a system for identifying, receiving, recording, handling and responding to complaints by patients.
• Governance arrangements were being operated effectively to ensure the delivery of care.

The areas where the provider should make improvements are:

Embed the improvements already made.

Continue to monitor care and treatment for patients as planned and provide regular reviews and assessment of needs in line with evidence based guidance.

Improve the uptake of cervical cancer screening for eligible women.

Improve the telephone system to improve access to appointments.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field CBE FRCP FFPH FRCGPChief

Inspector of General Practice

This practice is rated as inadequate overall.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires Improvement

Are services responsive? – Inadequate

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at Wenlock Terrace Surgery on 23 May 2018. The inspection was focussed on the branch site at Kimberlow Hill Surgery due to concerns that had been raised with us but both sites were visited by the inspection team. This inspection was carried out as part of our inspection programme. Wenlock Terrace Surgery was last inspected on 7 January 2016 and was found to be good in all of the key questions.

At this inspection we found:

• The practice did not have clear systems in place to manage risk so that safety incidents were less likely to happen.
• There were limited arrangements in place to review the effectiveness and appropriateness of the care being provided.
• Arrangements for monitoring and reviewing prescribing did not ensure that patients were kept safe.
• Arrangements were not in place to ensure that staff were working within the scope of their competency.
• During our inspection we saw that staff treated patients with compassion, kindness and respect.
• Patients found it difficult to get through to the practice by phone.
• Some patients found the online consultation form difficult to complete.
• Governance arrangements were not being operated effectively to ensure the delivery of high quality, sustainable care.

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.
• Establish and operate effectively a system for identifying, receiving, recording, handling and responding to complaints by patients.
• Ensure that staff receive appropriate support, training professional development, supervision and appraisal as is necessary to carry out the duties they are employed to perform.

The areas where the provider should make improvements are:

• Improve arrangements for the identification of carers to offer them support where needed.

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. The registered provider must not register any new patients at Wenlock Terrace Surgery or any location without the written permission of the Care Quality Commission.

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.

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 Unity Health on 7 January 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 a system in place for reporting and recording significant events.
• 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.
• Patients said they were treated with compassion, dignity and respect 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care.
• The practice had good facilities and was equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by the management team. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw areas of outstanding practice:

• The practice ran a ‘Stay and Wait’ surgery each week day morning at York Campus Health Centre. This was provided by two GPs and two experienced nurse prescribers. This allowed for urgent access to on the day consultations for the ambulant practice population.

• The practice provided an e-consulting service to all adult patients; they were responded to within the same working day.

The areas where the provider should make improvement are:

• Ensure all statutory notifications to the CQC are sent in a timely manner

• Ensure infection control audits are completed annually.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patients we spoke with were happy with the care and treatment they received from the practice team. Comments included:“They are wonderful.”,“ First class.” And “The team are very sensitive to the needs of someone with limited mobility.” They told us their views about their care and treatment were listened to and their needs were met.

Patients told us they did not have to wait too long for appointments, especially now you could come along to a ‘stay and wait drop in clinic’. We observed patients were welcomed in a professional, friendly manner.

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 on the day of inspection.

The clinical staff told us that they had plenty of opportunity to complete their Continuing Professional Development (CPD) and they were supported by the doctors and other team members. The reception staff were also positive about their personal development opportunities.

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

We carried out an announced comprehensive inspection at Wenlock Terrace Surgery on 23 May 2018. We identified four breaches of regulations and issued two warning notices and imposed a condition on the provider’s registration. The condition was ‘The registered provider must not register any new patients at Wenlock Street Surgery or Kimberlow Hill Surgery without the written permission of the Care Quality Commission’. This focused inspection carried out on 18 September 2018 was an announced focused follow-up inspection, without ratings, to check whether the provider had taken steps to comply with the legal requirements for these breaches of:

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3), Safe care and treatment

Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3), Receiving and acting on complaints

Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3), Good governance

Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3), Staffing

The full comprehensive report on the 23 May 2018 inspection can be found by selecting the ‘all reports’ link for Wenlock Terrace Surgery on our website at www.cqc.org.uk.

This report covers our findings in relation to those requirements.

Our key findings were as follows:

Improvements had been made with respect to the provision of safe care and treatment, receiving and acting on complaints, governance and staffing following our last inspection on 23 May 2018. For example:

•We found evidence of health and safety risk assessments, fire alarm checks, fire risk assessments and portable appliance testing for both sites.

•The provider had satisfied themselves that all clinical staff had medical indemnity insurance and professional registrations were current.

•The provider encouraged reporting of incidents. This had increased the effectiveness of reporting, lessons learned and feedback to staff

•The practice had systems in place to manage risk so that safety incidents were less likely to happen.

•There were arrangements in place to review the effectiveness and appropriateness of the care being provided.

•Arrangements for monitoring and reviewing prescribing helped ensure that patients were kept safe.

•Arrangements were in place to ensure that staff were working within the scope of their competency. Staff received appropriate support, training, professional development and appraisal as was necessary to carry out the duties they are employed to perform

•During our inspection we saw that staff treated patients with compassion, kindness and respect.

•Patients told us they found it easier to get through to the practice by phone.

•Governance arrangements were being operated effectively to ensure the delivery of care.

•The practice had established a system for identifying, receiving, recording, handling and responding to complaints by patients.

•Arrangements for the identification of carers and offer of support had improved.

Patients and staff told us that making an appointment to see a clinician was much easier.

Following this inspection, the condition has been removed from the provider’s registration due to the improvements made. The practice will remain 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.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice