The Little Surgery - Care Quality Commission

Background to this inspection

Updated 15 August 2017

The Little Surgery is located in Stamford which is a town on the River Welland in Lincolnshire.

There is direct access to the practice by public transport from surrounding areas. Whilst parking facilities are not provided on site, public car parks and on road parking is available within short walking distance.

The practice currently has a list size of approximately 3817 patients.

The practice holds a General Medical Services (GMS) contract. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

The practice is located within the area covered by South Lincolnshire Clinical Commissioning Group (CCG). The CCG is responsible for commissioning services from the practice. A CCG is an organisation that brings together local GP’s and experienced health professionals to take on commissioning responsibilities for local health services.

The practice is managed by two GP Partners (one male, one female). They are supported by one part time practice nurse. The practice has a dispensary on site with three members of staff working as dispensers. The practice also employs a team of reception, clerical and administrative staff.

The practice is open on Mondays to Fridays from 8am to 6.30pm. Appointments are available Mondays 8.30am to 6pm, Tuesdays 8.30am to 7.30pm, Wednesdays 8.30am to 6pm, Thursdays 8.30am to 6pm and Fridays 8.30am to 6pm. The practice is closed during weekends.

The practice has opted out of providing GP services to patients out of hours such as nights and weekends.

We inspected the following location where regulated activities are provided:-

The Little Surgery, 21 St Marys Street, Stamford, Lincolnshire. PE9 2DG

On the 1st July 2016 The Little Surgery Stamford became part of Lakeside Healthcare. (There are now three surgeries in Stamford who joined to formally merge in to a single ‘super-practice along with GP practices in Northamptonshire from 1 July 2016).

The Little Surgery is one of three surgeries in Stamford who merged with Lakeside Healthcare on 1 July 2016.

Patients who are registered at The Little Surgery took part in a recent consultation about merging the patient lists at St Mary’s Medical Centre, Sheepmarket Surgery and The Little Surgery to create one practice in Stamford.

The consultation ended on 1 May 2017 and the feedback was discussed with NHS England and South Lincolnshire Clinical Commissioning Group. The application to merge was approved and the new practice will be called Lakeside Healthcare Stamford.

From 22nd September 2017 The Little Surgery Stamford will relocate to The Sheepmarket Surgery, Ryhall Rd, Stamford PE9 1YA.

On 22 November 2017, The Little Surgery will merge its clinical system with The Sheepmarket Surgery and St Mary’s Medical Centre. From 23 November 2017 all patients from the three practices will then be registered with Lakeside Healthcare Stamford.

The Little Surgery Stamford had opted out of providing out-of-hours services (OOH) to their own patients. The OOH service is provided by Lincolnshire Community Health Services NHS Trust.

Overall inspection

Inadequate

Updated 15 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Little Surgery Stamford on 30 June 2016. The overall rating for the practice was requires improvement .Safe and Well-led were requires improvement. Effective, Caring and Responsive were rated as Good. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for The Little Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 March 2017 and a further visit on 13 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 30 June 2016. This report covers our findings in relation to those requirements, additional improvements made since our last inspection and any areas concerns since the last inspection.

Following the most recent inspection we found that overall the practice was rated as inadequate. We found that both Safe and well-led were now also rated as inadequate.

Patients were at risk of harm because some of the systems and processes in place were not effective to keep them safe. For example, in the areas of significant events, management of high risk medicines, medication reviews, recall of patients with long term conditions, and staff training.

Not all risks were assessed and well managed.
We found that in some cases medication reviews were not being carried out appropriately to ensure the safe prescribing and monitoring of continued prescribing of medicines for patients. Patient care records in relation to some medication reviews were not found to be factually accurate and did not represent the actual care and treatment of patients.
The system in place to monitor the training of the GPs and staff within the practice was not effective. For example, not all clinical staff had received appropriate training in safeguarding to ensure they were up to date with current procedures.
Formal governance arrangements needed to be reviewed to ensure they were effective.

The areas where the provider must make improvements are:

Assess, monitor and improve the quality and safety of the services provided. For example, For example, in the areas of significant events, management of high risk medicines, medication reviews, recall of patients with long term conditions, and staff training
Assess, monitor and mitigate the risk relating to the health, safety and welfare of service users and others who may be at risk, For example, fire, legionella and electrical safety.

The areas the provider should make improvements are:

Ensure there is information for carers available in the practice.
Regularly review standard operating procedures to ensure they remain fit for purpose.
Implement a lone working policy for the dispensary.
Perform regular competency assessments for dispensary staff.
Implement a system for tracking blank prescription forms through the practice in accordance with national guidance.

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 FRCGP

Chief Inspector of General Practice