Upton Road Surgery

This practice is rated as requires improvement overall. (Previous rating 12 December 2018 – Inadequate)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Upton Road Surgery on 12 December 2018. The overall rating for the practice was inadequate and the practice was placed into special measures for a period of six months. Warning notices were served in relation to breaches identified under Regulation 12 Safe care and treatment and Regulation 17 Good governance. The practice was placed into special measures for a period of six months.

We completed an announced focussed inspection on 9 May 2019 to check on the areas identified in the warning notices and to see if sufficient improvements had been made regarding these. Improvements were evident, and the practice had acted to comply with the legal requirements.

The full comprehensive report from the December 2018 inspection and the focussed report for the May 2019 can be found by selecting the ‘all reports’ link for Upton Road Surgery on our website.

This announced comprehensive inspection on 8 August 2019 was carried out following the period of special measures to ensure improvements had been made and to assess whether the practice could come out of 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.

We have rated this practice as requires improvement overall. We rated all population groups as requires improvement because of the issues identified in the effective and responsive domains.

We rated safe and caring as good because:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.

We rated effective as requires improvement because:

• Care for people with long term conditions needed improvement.
• Childhood immunisation uptake rates were below the World Health Organisation (WHO) targets.
• The operation of the ‘failsafe system’ to check on outstanding cytology results needed improvement.

We rated responsive as requires improvement because:

• Patients satisfaction in relation to access care and treatment in a timely way in the 2019 National GP Survey had significantly decreased in comparison to the 2018 National GP Survey results.

We rated well led as requires improvement because:

• The practice had implemented systems that provided leadership and governance which had promoted a positive culture to support inclusive patient centred care. However, systems and process to review clinical and quality monitoring were not fully established.

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).

The areas where the provider should make improvements are:

• Improve patient satisfaction (based on 2019 national GP survey results).

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 Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced focused inspection of Upton Road Surgery on 9 May 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 12 December 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 December 2018 inspection can be found by selecting the ‘all reports’ link for Upton Road Surgery on our website.

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.

• Governance arrangements in the practice had been strengthened. Meetings were formalised, and policies and procedures we reviewed had been updated. Permanent management arrangements were still being formalised. In the interim, a consultancy company was assisting the practice to establish leadership and management systems and providing day to day steer.
• Systems in place to ensure the safety of medicines that needed refrigerated storage had been improved.
• Systems had been implemented to manage and act upon Medicines and Healthcare products Regulatory Agency (MHRA) and other safety alerts.
• The process for identifying clinical and other audits relevant to patient care had been strengthened and there was evidence of audits in progress and completed.
• Risks associated with infection control had been identified and acted upon.
• Evidence of pre-employment checks were now available, and staff had received a disclosure and barring (DBS) check where relevant. Staff who acted as chaperone had been trained.
• The practice had reviewed the immunisation status of applicable employees and maintained a spreadsheet. This was work in progress and were expected to be completed by 1 June 2019.
• The practice was acting to implement the recently revised intercollegiate guidance 'Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff' to ensure practice nurses met the revised training requirements.
• Training needs of staff had been reviewed and records of staff mandatory training (as specified by the practice) were now maintained.
• Clinical staff had received regular appraisals, and appraisals for non-clinical staff were planned to happen very shortly.
• Records of significant events and complaints were maintained and handled according to practice policy.
• Areas of learning and improvement were shared, and actions taken where needed.
• Measures were in place to ensure the adequacy of practice premises, so care was delivered in an environment that was safe for patient and staff and ensured confidentiality.
• Following the formalisation of the service level agreements for the provision of care to patients living in two care homes, the practice had taken steps to ensure affected patients or their legal representatives had consented to the transfer of care from their previous provider.

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 Upton Road Surgery on 12 December 2018. We gave the practice 48 hours notice of the inspection. We carried out this inspection due to concerns which had come into the Commission from a number of different sources.

We had previously inspected the practice on 24 August 2016 and had rated the practice as ‘Good’. Since our last inspection some significant changes had taken place at the practice which included the practice taking over a substance misuse service. This had happened at short notice for the practice and had been in place at the practice since 1 October 2018.

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 because:

• The practice did not have clear systems and processes to keep patients safe.
• Staff were not being safely recruited.
• The practice did not have appropriate systems in place for the safe management of medicines.
• The practice did not learn and make improvements when things went wrong.
• The premises were not safe and suitable for staff, patients and visitors to use.

We rated the practice as requires improvement for providing effective, caring and responsive services because:

• Improvement was needed in how staff were developed and supported at the practice.
• Consent was not being sought appropriately or in line with legal requirements.
• The practice had not responded to the care and treatment needs of people who resided in a care home which had been aligned to the practice. These patients had not been treated with dignity or respect.
• There was limited evidence in relation to how patients could feedback on how the practice was run.
• The practice had not made the changes it needed to in order to respond to the needs of the additional substance misuse service it had recently taken over.

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

• There was no clear governance structure in place at the practice. Roles and responsibilities were not clearly defined.
• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
• The practice lacked a clear vision and there was no credible strategy in place.
• 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 recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

• Improve the uptake of patients for the national cancer screening programme.
• Improve the monitoring and review of patients suffering with diabetes, as highlighted in the Quality and Outcomes Framework data for 2017/18.

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

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 FRCGP
Chief Inspector of General Practice