The Care Quality Commission
  • Doctor
  • GP practice

Park Street Surgery Also known as Dr Ingram & Partners

Overall: Good read more about inspection ratings

The Surgery, 7-8 Park Street, Ripon, North Yorkshire, HG4 2AX (01765) 692337

Provided and run by:
Park Street Surgery

All Inspections

21 June 2023

During a routine inspection

We carried out an announced comprehensive inspection at Park Street Surgery on 14 and 21 June 2023. Overall, the practice is rated as good.

Safe - Good

Effective - Good

Caring - Good

Responsive - Good

Well-led - Good

Following our previous inspection on 3 and 9 November 2022, the practice was rated inadequate overall and for the key questions of safe and well led, and placed into special measures.

For providing effective services, the practice was rated as requires improvement. The areas of caring and responsive services were not inspected in 2022, instead the previous ratings of good carried forward from the practices’ first inspection on 20 January 2016.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Park Street Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection, and the previous rating in line with our inspection priorities and special measures guidance.

This inspection included all the key questions of safe, effective, caring, responsive and well led. In addition we assessed compliance with 2 warning notices issued at the previous inspection under regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, these pertaining to safe care, and good governance.

How we carried out the inspection/review

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing and questionnaires.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A site visit.

Our findings

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 found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm. There had been significant improvements in incident recording, reporting and analysis. Safeguarding procedures and the updating and review of safeguarding registers had improved since the previous inspection.
  • Patients received effective care and treatment that met their needs. The provider was able to evidence improvements in patient care and the management of long-term health conditions. There was a comprehensive programme of clinical audit, and evidence of quality improvement initiatives improving patient outcomes.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care. There was a strong cohesive staff team, who spoke positively about their leaders. There had been improvements in governance and clinical leadership. Clinical leads took ownership of their respective areas and communicated required changes in a clear and timely manner.
  • The practice had made good use of available technology to automate reminders and review dates for staff, which led to more efficient working and improved patient outcomes.

Whilst we found no breaches of regulations, the provider should:

  • Deliver to completion, in line with given timescales, the programme of improvement works identified in the infection control audit.
  • Actively search for and check that urgent cancer referrals have been completed and that the patient attended their appointment.
  • Carry out regular retrospective auditing of historical safety alerts to ensure these were actioned correctly at the time.
  • Continue to encourage the uptake of cervical screening tests and childhood immunisations.

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

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

3 and 9 November 2022

During an inspection looking at part of the service

We carried out an announced focused inspection at 7 & 8 Park Street (also known as Dr Ingram & Partners) on 3 and 9 November 2022. Overall, the practice is rated as inadequate.

The ratings for each key question are:

Safe - Inadequate

Effective – Requires improvement

Caring – Not inspected - rating of good carried forward from previous inspection

Responsive – Not inspected - rating of good carried forward from previous inspection

Well-led - Inadequate

Following our previous inspection on 20 January 2016, the practice was rated good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for 7 & 8 Park Street on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection in line with our inspection priorities.

How we carried out the inspection/review

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing and obtaining feedback from staff using electronic questionnaires.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records.
  • Requesting evidence from the provider.
  • A short site visit.

Our findings

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 found that:

  • The practice did not always provide care in a way that kept patients safe and protected from avoidable harm.
  • There were inadequate systems to assess, monitor and manage risks to patient safety. Systems were not embedded to keep people safe and safeguarded from abuse.
  • Patients did not always receive effective care and treatment that met their needs. The practice did not always routinely review the effectiveness and appropriateness of the care it provided.
  • All staff told us that leaders were visible and approachable. They said they were well supported.
  • Governance processes were inadequate to manage risk.
  • The provider was unable to demonstrate effective and capable leadership.

We found breaches of regulations. The provider must:

  • 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.

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 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.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

20 January 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at 7 & 8 Park Street on 20 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 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.
  • 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 that 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 (i.e. any patient harmed by the provision of a healthcare service is informed of the fact and an appropriate remedy offered, regardless of whether a complaint has been made or a question asked about it).

However, there was also an area of practice where the provider needs to make improvements.

  • The practice should regularly perform and record balance checks of controlled drugs in line with current guidance.
  • The practice should ensure that appropriate records are kept relating to all aspects of medicines management.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice