All inspections: The Summitt Practice - Care Quality Commission

We carried out an announced comprehensive inspection at The Summitt Practice on 01 October 2021. Overall, the practice is rated as requires improvement.

Set out the ratings for each key question

Safe - Requires improvement

Effective – Requires improvement

Caring - Good

Responsive - Good

Well-led – Requires improvement

Following our last inspection on 10 February 2020, the practice was rated requires improvement overall and rated good for caring and responsive but requires improvement for providing safe, effective and well led services.

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

Why we carried out this inspection

This inspection was a comprehensive inspection to follow up on breaches of regulations and covers our findings in relation to the actions we told the practice they should take to improve:

How we carried out the inspection

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 was with consent from the provider and in line with all data protection and information governance requirements.

This included:

Conducting staff interviews using video conferencing
Completing clinical searches on the practice’s patient records system and discussing findings with the provider
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 have rated this practice Requires Improvement overall.

We found that:

The practice had addressed most of the issues identified at the last inspection, however, at this inspection we found arrangements for identifying, monitoring and managing risks to patient safety required improvement. For example, people had not received appropriate physical health monitoring with appropriate follow-up in accordance with current national guidance.

The practice had a written protocol for repeat prescribing of medicines which needed monitoring, however, clinicians had not followed the protocol to ensure appropriate monitoring and prescribing has been carried out.

The provider had not ensured clinicians had acted sufficiently on abnormal test results and that results were clearly recorded in patient records. We found patients’ records were not appropriately coded in order to support the effective delivery of care.

Staff dealt with patients with kindness and respect and involved them in decisions about their care.

The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.

Childhood immunisation uptake rates were below the World Health Organisation (WHO) targets. Uptake rates for the vaccines given were below the target of 95% in five areas where childhood immunisations are measured.

The practice had not demonstrated it had an effective strategy to improve its performance for cervical screening which was lower than CCG and England averages.

The way the practice was led and managed promoted the delivery of high-quality, person-centre care. However, overall governance arrangements in place required improvement. For example, the provider did not have oversight of staff training and could not easily evidence the training undertaken by staff.

We found evidence of quality improvement measures including clinical audits and reviews. There was evidence of action taken to change practice.

The provider must:

Ensure that care and treatment is provided in a safe way.
Ensure that persons employed in the provision of a regulated activity received such appropriate support, training, professional development, supervision and appraisal as was necessary to enable them to carry out the duties they were employed to perform.

The provider should:

Improve recording of DNACPR decisions.
Continue to implement a programme to improve uptake for cervical screening and childhood immunisations.
Take action to increase the number of carers identified, in order that they can provide support to these patients.
Improve compliance with policies and procedures; for example, the prescribing policy.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at The Summitt Medical Practice on 10 February 2020.

The inspection was a comprehensive follow up inspection to check whether or not sufficient improvement had been made since our last comprehensive inspections on 4 January 2019 and 5 August 2019. At these inspections we found issues around safety management, governance and recruitment procedures, as well as the low uptake of childhood immunisations. As a result of our findings at these previous inspections, the practice was placed in special measures.

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.

At this inspection on 10 February 2020, we rated the practice as requires improvement overall. We rated all population groups as good with the exception of working age people (including those recently retired and students) and families and young children which we rated as requires improvement.

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

The practice had failed to return patients’ records (Lloyd George patient records) promptly, when patients had left the practice. This meant that patients’ complete medical notes would not have accompanied them to their new practice.
The system to ensure that clinical staff had the correct patient group directions (PGDs) in place to authorise their administration of medicines was sometimes ineffective.
The practice had not always removed medicines that patients were no longer taking from the computer system. This meant that the patient record did not have an up to date list of medicines.
The service had good systems in place to safeguard both adults and children.
The service had appropriate standards for infection control.

We rated the practice as requires improvement for providing an effective service because: -

Although improvements had been made further work was required to ensure the practice met the national targets for both child immunisations and cervical screening.
The service had good systems in place for the recall of patients with long-term conditions.

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

The practice had to further embed systems and processes to ensure a quality service.

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

The service had responded to complaints.
Patients were able to access appointments in a timely way.
The practice had carried out their own survey and the doctors had carried out an audit to review their consultations.

The areas where the provider must make improvements are:

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).

We have removed the practice from special measures due to the improvements the practice has made.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at The Summitt Medical Practice on 5 August 2019. This inspection was a comprehensive follow up inspection to check whether or not sufficient improvement had been made since our last comprehensive inspection on 4 January 2019. At that inspection we had found issues around safety management, governance and recruitment procedures, as well as the low uptake of childhood immunisations.

As a result of our findings at that inspection, the practice was rated as inadequate and placed into special measures for a period of six months. Warning Notices were issued under Regulations 12 and 17 of the Health and Social Care Act 2008. These were followed up at an inspection which took place on 9 May 2019. At that inspection we found improvements had been made and the issues contained within the warning notices had largely been addressed. However additional breaches of Regulation 17 were found in relation to record keeping and risk management.

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 and requires improvement for all population groups.

We found that:

•The practice provided care in a way that kept patients safe and protected them from avoidable harm.

•Patients did not always receive effective care and treatment that met their needs.

•Patient’s overall experience of appointments was not always positive.

•The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

•The way the practice was led and managed did not always promote the delivery of high-quality, person-centre care.

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

There was limited evidence of quality improvement activity.
We have rated one of the population groups in the effective key question as inadequate and the other populations groups as requires in improvement. This means that the effective key question is rated requires improvement overall.

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

Feedback from patients was variable about the way staff treated people.

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

While the practice had made some improvements since out inspection on 4 January 2019, performance around patient experiences of appointments remained persistently below average. Measures taken by the practice to improve had not demonstrated material improvement.

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

The practice provided care in a way that kept patients safe and protected them from avoidable harm.
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:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. Specifically, in respect of quality improvement activity and the practice’s performance in the National GP patient survey.

The areas where the provider should make improvements are:

Review and improve the sharing of information about premises safety with the landlord.
Review and improve performance in childhood immunisations and cervical screening.
Review and improve quality improvement activity, particularly activities which are independent of local initiatives.
Continue to and improve patient feedback about their experience of appointments.

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

Due to the inadequate rating for one of the population groups this 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. 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 FRCGPChief

Inspector of General Practice

Overall summary

We previously carried out an announced comprehensive inspection of The Summitt Practice on 4 January 2019 and found that the practice was in breach of Regulation 12: ‘Safe care and treatment’ and Regulation 17 ‘Good governance’ of the Health and Social Care Act 2008. In line with the Care Quality Commission’s (CQC) enforcement processes, we issued warning notices which required The Summitt Practice to comply with the Regulations by 29 March 2019. The full report of the 4 January 2019 inspection can be found by selecting the ‘all reports’ link for The Summitt Practice on our website www.cqc.org.uk.

We carried out this announced focused inspection on 9 May 2019 to check whether the practice had addressed the issues in the warning notice and now met the legal requirements. This report covers our findings in relation to those requirements and will not change the current ratings held by the practice.

At the inspection on 9 May 2019 we found the provider had acted to address all the requirements of the Regulation 12 warning notice and most of the Regulation 17 warning notice.

Our key findings were as follows:

Emergency medicines and equipment were fit for use and related checks were implemented.
Significant events and safety alerts were identified, documented and followed up.
Risk assessments for fire and premises safety had been carried out, but the provider was not assured the frameworks were suitable .
There was an effective induction system for temporary staff tailored to their role.
The practice had systems for the appropriate and safe use of medicines.
Staff had the information they needed to deliver safe care and treatment.
The practice had a vision, but it was not supported by a credible strategy or action plans to underpin high quality sustainable care.
Processes for managing risks, issues and performance had been implemented but their effectiveness was not assured.

The areas where the provider must make improvements are:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and evidence table for further information.

We carried out an announced comprehensive inspection at The Summitt Practice on 4 January 2019.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 16 November 2017 when the practice was rated as requires improvement for safety, caring, being well-led, and overall.

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 including because:

There were gaps in staff recruitment processes and checks.
There were weaknesses and shortfalls in health and safety arrangements including risk assessments in areas such as fire and premises, and Control of Substances Hazardous to Health (COSHH).
Emergency medicines and equipment were not always provided or checked as fit for use. This issue was repeated after we highlighted it at our previous inspection on 16 November 2017.
There was no failsafe system to ensure results sent for the cervical screening program were received or missing results follow up. A search showed there were 25 cervical screening samples taken between 2016 and 2018 where no results were received, and the practice had not acted to address this.
There was insufficient identification, documentation, and management of significant events to improve safety.
Patient Group Directions (PGDs) were not properly signed and authorised. (PGDs are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment).

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

Leaders had not addressed several of the risks and concerns we identified at our previous inspection 16 November 2017.
The practice did not always hold or act on appropriate and accurate information.

We rated the practice as Requires improvement for providing caring services because:

The practice had not accurately identified patients that are carers to ensure appropriate support could be provided to them. This issue was repeated after we highlighted it our previous inspection on 16 November 2017.
The practice GP Patient survey data relating to caring services was slightly but consistently lower than average and there was no evidence of action taken to improve, although one of the indicators had improved. This issue was repeated after we highlighted it our previous inspection on 16 November 2017.

We rated the practice as Good for providing effective services because:

Some cancer performance data was lower than average, but patients otherwise received effective care and treatment that met their needs.
Patient’s care and treatment was delivered in line with current legislation, standards and evidence-based guidance.

We rated the practice as Good for providing responsive services because:

The practice organised and delivered services to meet patients’ needs.
Complaints were listened and responded to and used to improve the quality of care.

These areas affected all population groups, so we rated all population groups as Good.

The areas the provider must improve:

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.
Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed and specified information is available regarding each person employed.

The areas the provider should improve:

Continue to work to improve the uptake of childhood immunisation rates.

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 FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as requires improvement overall. (Previous inspection 06 2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Requires improvement

Are services responsive? – Good

Are services well-led? – Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) – Requires improvement

We carried out an announced comprehensive inspection at The Summit Practice on 16 November 2017 as a part of our inspection programme.

At this inspection we found:

The practice had limited systems to monitor the effectiveness of processes such as infection control, we found that the nurse’s room was visibly dirty and there was a full sharps bin left on the floor.
The processes for monitoring and managing emergency medicines and equipment were not effective, there was no delivery system for the oxygen and the supply of emergency medicines included the wrong adrenaline. This was addressed by the end of the inspection.
Data from the national GP patient survey showed the practice was mostly rated below the national averages for all aspects of care. The practice had begun to work on ways to improve this.
Clinical audits demonstrated quality improvement.
There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
The practice did not routinely review the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence- based guidelines.
The practice held regular meetings where all staff members were invited and practice achievements and targets were discussed.
Staff involved and treated patients with compassion, kindness, dignity and respect.
The practice worked closely with the patient participation group (PPG) and had a weekly health walk in a local park with them.

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:

Continue to work to improve patient satisfaction with services provided.
Continue to work to improve the uptake of childhood immunisation rates and bowel screening.
Continue to work to identify patient carers and provide appropriate care to them.

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 the Summitt Practice on 3 June 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to be good for providing well-led, caring, and responsive services. We found the practice to require improvement for providing a safe and effective service. It also required improvement for providing services for the care provided to older people, people with long term conditions and for people experiencing poor mental health (including people with dementia)., families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable.

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

Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
Patients said they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.
Information about services and how to complain was available and easy to understand.
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.

However, there were areas of practice where the provider needs to make improvements.

Importantly the provider must:

Ensure all nonclinical staff acting as chaperones have a Disclosure and Barring Service (DBS) check or have risk assessments in place.
Ensure all equipment is calibrated.
Ensure appraisals of the nursing staff are undertaken.

The provider should:

Ensure all out of date medical equipment is disposed of, including out of date swabs and syringes.
Ensure all diabetic reviews are undertaken.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Archived: The Summitt Practice

All Inspections

01 October 2021

During a routine inspection

10 February to 10 February 2020

During a routine inspection

05 August 2019

During a routine inspection

9 May 2019

During an inspection looking at part of the service

4 January 2019

During a routine inspection

16 November 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field CBE FRCP FFPH FRCGP

3 June 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)