We carried out an announced focused inspection of West Street Surgery on 27 February 2019. This inspection was undertaken to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation set out in warning notices we issued to the provider in relation to Regulation 12 Safe care and treatment and Regulation 17 Good governance.

The practice received an overall rating of inadequate at our inspection on 19 September 2018 and this will remain unchanged until we undertake a further full comprehensive inspection within six months of the publication date of the initial report.

The full comprehensive report from the September 2018 inspection can be found by selecting the ‘all reports’ link for West Street Surgery on our website at .

Our key findings were as follows:

• The practice had complied with the warning notices we issued and had taken the action needed to comply with the legal requirements.
• The practice had conducted risk assessments for fire and health and safety and had plans for completing any actions identified.
• The practice had developed logs for complaints, significant and safety alerts and these were shared with practice staff at clinical meetings.
• The practice had improved infection control practices.
• The practice had developed a training matrix to maintain oversight of staff training needs. Most staff had completed mandatory training.
• The practice had begun a programme of staff appraisal where clinical competence was assessed and evaluated.
• Staff told us that they felt more supported however some staff still felt undervalued.
• Communication between the management and staff teams had improved however reception staff had not been included in meetings.

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

This practice is rated as inadequate overall.

(Previous rating November 2016 – Good)

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 West Street Surgery on 19 September 2018, under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was carried out in response to concerns raised regarding the leadership at the practice. The full comprehensive report on the September 2018 inspection can be found by selecting the ‘all reports’ link for West Street Surgery on our website at

www.cqc.org.uk

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At this inspection we found:

• The practice had ineffective systems to manage risk. When incidents did happen, the practice did not share learning from them or improve their processes.
• There was a lack of oversight of complaints, significant events and safety alerts. This led to a lack of learning from these events.
• Not all staff had completed the required mandatory training.
• There were ineffective processes around safeguarding of vulnerable adults and children. Not all staff had received safeguarding training.
• There were gaps in the system used for prescribing certain high risk medicines. The practice could not provide evidence to assure us that blood test results were always reviewed prior to prescribing.
• Staff immunisations were not recorded for both clinical and non-clinical staff.
• We found gaps in record keeping to support appropriate monitoring of the cold chain, as vaccination fridge temperatures were not consistently recorded.
• Not all patients had care plans recorded on the system to assess their medical condition where appropriate.
• Staff did not always feel supported, regular appraisals and training were not carried out. There were poor communication structures within the practice.
• Staff involved and treated patients with compassion, kindness, dignity and respect. Results from the latest National GP Patient Survey showed patients were satisfied with their interactions with reception staff and consultations with GPs and nurses.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.

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:

• Proactively identify carers and ensure they are given appropriate support.

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.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at West Street Surgery on 6 July 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. However we found that the practice had not always updated patient records with monitoring information when they received high risk medications.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
• 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 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.

The areas where the provider should make improvement are:

• Continue to monitor the recently implemented protocol to ensure children who fail to attend a hospital appointment (DNA) are easily identified and acted on.

• Ensure a system is implemented to ensure that all monitoring results of patients receiving repeat high risk medications are recorded within patient records.

• Continue to monitor the recently introduced communication pathway to the out of hours provider (OOH) to keep them informed of specific patients who may need care outside of normal practice hours and at weekends.

• Continue to monitor and act on the results of the national patient survey.

• Improve record keeping in relation to complaints to ensure verbal communication with complainants is recorded in the complaints file.

• Continue to identify and support carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice