Summervale Surgery

We carried out an announced focused inspection at Summervale Surgery on 26 February 2020. Following our comprehensive inspection at Summervale Surgery (7 August 2019) the location was rated as inadequate with an inadequate rating for safe, effective and well-led and a good rating for caring and responsive.

Following this inspection (August 2019) we placed the service into special measures. The serious concerns were such that we took further steps to ensure the provider made changes to the governance of the service to reduce or eliminate the risks to patients. The provider was required to make improvements in respect of these specific deficits, as outlined in the warning notices.

We issued warning notices in regard to:

• Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good Governance
• Regulation 18(2) of the Health and Social Care Act (Regulated Activity) Regulations 2014, Staffing.
• Regulation 19(1)(2)(3) of the Health and Social Care Act (Regulated Activity) Regulations 2014, Fit and proper persons employed.

A focused follow up inspection was undertaken on the 27 November 2019 to check the progress the provider was making in regard to the regulatory breaches set out within the warning notices. At this inspection we found significant steps had been taken to address areas of concern. As a result we told the provider there were areas of the service where they needed to make improvements. We issued requirement notices:

• Ensure patients are protected from abuse and improper treatment
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

At this inspection (26 February 2020) we rated the practice as Good overall.

The key questions are rated as:

Are services safe? Good

Are services effective? Good

Are services caring? Good

Are services responsive? Good

Are services well-led? Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

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.

There were areas where the provider should:

• Have a process in place to regularly review the dispensary standard operating procedure (SOP) against national guidance.
• Consider an overarching document to access themes and trends for significant events and incidents.
• Continue to work towards the improving the quality of care for diabetic patients through appropriate monitoring and actions to reduce clinical complications.
• Continue to work towards completion of annual reviews for people living with mental health.
• Consider an overarching document to demonstrate the practice’s annual audit and quality improvement plan.
• Continue to work towards completion of annual appraisals in a timely manner.
• Record negative feedback from the Friends and Family Test within the overarching complaint log to allow for easy identification of themes and trends.

This service was placed in special measures in August 2019 in order for the provider to take steps to improve the quality of the services it provided. I am taking this service out of special measures. This recognizes the significant improvements 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 Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced focused inspection at Summervale Surgery on 27 November 2019. Following our comprehensive inspection at Summervale Surgery (7 August 2019) the location was rated as inadequate with an inadequate rating for safe, effective and well-led and a good rating for caring and responsive.

Following this inspection we placed the service into special measures. The serious concerns were such that we took further steps to ensure the provider made changes to the governance of the service to reduce or eliminate the risks to patients. The provider was required to make improvements in respect of these specific deficits, as outlined in the warning notices of 23 August 2019 to be completed by 15 November 2019.

We issued warning notices in regard to:

• Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good Governance
• Regulation 18(2) of the Health and Social Care Act (Regulated Activity) Regulations 2014, Staffing.
• Regulation 19(1)(2)(3) of the Health and Social Care Act (Regulated Activity) Regulations 2014, Fit and proper persons employed.

This focused follow up inspection was undertaken on the 27 November 2019 to check the progress the provider was making in regard to the regulatory breaches set out within the warning notices. Other areas of non-compliance were planned to be reviewed at a later date by a comprehensive inspection when the provider has had time to implement all the changes required.

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 provider had taken steps to ensure the significant concerns that had been found in relation to the warning notices had or were in the process of being addressed. For example, we found evidence that the concerns around infection prevention and control, management of emergency medicines such as Oxygen and health and safety relating to risk assessments and COSHH (control of substances harmful to health) had been addressed and improved.
• The provider had implemented changes to the management and administration system for safer recruitment and for mandatory learning and development. However there were still gaps in the safer recruitment process and the completion of mandatory training.
• A review of the quality improvement scheme (QOF) showed improvement in terms of improved management of the system. They were able to demonstrate quality indicators for the management of chronic disease criteria was improving.
• The practice had an action plan which demonstrated work was being taken to improve systems and processes . The implementation of an overarching governance framework for systems and processes required further attention to improve the quality and safety of the services and to mitigate risks relating to the health, safety and welfare of staff and service users.
• Staff told us communication and leadership within the practice had improved. They felt included and updated with regards to the changes. They told us leaders were visible and listened to concerns.

There were areas of the service where the provider needs to make improvements.

Importantly, the provider must:

• Ensure patients are protected from abuse and improper treatment
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

There were areas where the provider should:

• Continue to review and update where necessary risks assessments relating to health and safety at work. For example, the actions from the fire risk assessment.
• Complete annual appraisals for all staff in line with practice policy.
• Continue to review and update staff files in line with NHS guidance.
• Consider processes to identify vulnerable patients such as people living with dementia, veterans and bereaved families.
• Continue to take action to improve emergency admission rates and admission rates to hospital due to respiratory concerns.
• Continue to imbed clinical supervision for clinical staff including a formal system to document non-medical prescriber competencies.
• Continue to work towards completion of staff appraisals in line with practice policy.

The service remains under special measures until we have returned to carry out a comprehensive inspection at the end of this six month period after the initial report was published. If the service has failed to make sufficient improvements the CQC will consider taking steps to cancel the provider’s registration.

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

This service is rated as Inadequate overall. (Previous inspection September 2016 – Good)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

We rated all of the population groups as inadequate.

We carried out an announced comprehensive inspection at Summervale Surgery on 7 August 2019 following an Annual Regulatory Review of the information available to us and information received in. This inspection looked at the key questions Safe, Effective, Caring, Responsive and Well-led as well as all the population groups.

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 rated the practice as inadequate for providing safe services because:

• The practice did not have clear systems and processes to keep patients safe.
• The practice did not have appropriate systems in place for the safe management of emergency medicines and equipment.

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

• There was limited monitoring of the outcomes of care and treatment.
• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.
• Staff did not receive ongoing supervision or regular appraisals of their performance so training and development needs were not identified.
• Some performance data was significantly below local and national averages.

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

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice respected patients’ privacy and dignity.

We rated the practice as requires improvement for responsive services because:

• Patients were not always able to access appointments in a timely way. For example, usage of locum practice nurses meant clinics could be cancelled at short notice.
• The practice could not demonstrate they listened to, acted, recorded or learned from verbal complaints.

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

• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
• While the practice had a clear vision, that vision was not supported by a credible strategy.
• The practice culture did not effectively support high quality sustainable care.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.

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.
• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

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

As part of this inspection process we have issued the provider with Warning Notices. We can issue Warning Notices to a registered person where the quality of the care they are responsible for falls below what is legally required. Legal requirements can include the Health and Social Care Act 2008 (‘the Act’) and the regulations made under it, but also other legislation that registered persons are legally obliged to comply with in delivering the service.

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.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care