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Reports


Review carried out on 29 January 2020

During an annual regulatory review

We reviewed the information available to us about Peartree Surgery on 29 January 2020. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 11 September 2018

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at Peartree Surgery on 27 July 2017. The overall rating for the practice was good with requires improvement for providing responsive services. The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link for Peartree Surgery on our website at www.cqc.org.uk.

This inspection was an announced desk based focused inspection carried out on 11 September 2018 to confirm that the practice had made the recommended improvements that we identified in our previous inspection on 27 July 2017. This report covers our findings in relation to those improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

  • The practice had comprehensive systems in place to collect and review patient feedback and audit their telephone and appointment booking systems. An improvement plan had been put in place in 2017 in order to increase access and improve patient experience.
  • The practice and the Patient Reference Group completed patient surveys on an ongoing basis and the practice carried out regular audits to manage busy periods and monitor their appointment and telephone system.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 27/07/2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Peartree Surgery on 19 October 2016. Overall the rating for the practice in 2016 was inadequate; specifically it was rated inadequate for safe and well-led, requires improvement for effective and responsive and good for caring, and was placed in special measures for a period of six months.

This report follows an inspection that was undertaken following the period of special measures and was an announced comprehensive inspection carried out on 27 July 2017; overall the practice is now 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 a system in place for reporting and recording significant events. The practice had clearly embedded systems and processes which promoted learning from events and clear communication with all staff members.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety. Processes and fail-safe systems were in place for the effective monitoring of patients receiving high risk medicines and management of clinical records.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Systems and processes in place to provide supervision to clinical staff and identify staff learning needs were effective.
  • Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • Most recent results from the National GP Patient Survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Staff felt supported by management and the practice proactively sought feedback from staff and patients, which it acted on.
  • 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvements are:

  • Continue to review and ensure improvement to the national GP patient survey results, including access to the practice by telephone.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service. We encourage the practice to sustain and embed the improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 26/01/2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at Peartree Surgery on 26 January 2017. This inspection was undertaken to follow up on a Warning Notice we issued to the provider and the registered manager in relation to:

  • Regulation 12; Safe Care and Treatment with regards to areas of unmanaged risk to patients receiving high risk medicines, medicines which require monitoring and the management of clinical documentation including pathology results and discharge letters.

The practice received an overall rating of inadequate at our inspection on 19 October 2016. We issued a warning notice and this report only covers our findings in relation to the areas identified in the warning notice as requiring improvement during our inspection in October 2016. You can read the full report from our last comprehensive inspection in October 2016, by selecting the 'all reports' link for Peartree Surgery on our website at www.cqc.org.uk.

The areas identified as requiring improvement in the warning notice were as follows:

  • We found that the system for checking the monitoring of high risk medicines was not effective.
  • We found some patients receiving medicines that required monitoring had not received the appropriate checks.
  • We found systems and processes in place for the safe and effective management of clinical documentation was not adequate.

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

  • The practice had complied with the warning notice we issued and had taken the action required to comply with legal requirements.
  • There was a safe and effective system in place for the management of patients receiving medicines that require monitoring, including high risk medicines.
  • The practice had an effective system in place for the safe and timely management of clinical documentation including pathology results and discharge letters.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 19/10/2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Peartree Surgery on 19 October 2016. Overall the practice is rated as inadequate.

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

  • Patients were at risk of harm because systems and processes in place were not adequate to ensure patients received the required checks before being prescribed high risk medicines. The management of clinical records from secondary care services was ineffective.
  • The system in place for identifying and recording significant events was not effective.
  • The practice had insufficient clinical leadership capacity and not all governance structures, systems and processes were effective and enabled the provider to identify, assess and mitigate risks to patients, staff and others.
  • Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, the system and process to identify staff learning needs was not effective.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • 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, however the provider did not follow their complaints procedure when responding to complaints.
  • 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.

The areas where the provider must make improvements are:

  • Ensure the systems and processes are in place for safe prescribing of medicines, including high risk medicines, and the timely management of clinical records received into the practice, including secondary care clinical notifications and pathology results.

  • Ensure systems are implemented to enable staff learning needs to be identified through a system of staff appraisals.

  • Ensure completion and effective management of the actions identified in the Legionella risk assessment.

  • Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.

  • Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.
  • Ensure processes are improved to enable effective communication.

The areas where the provider should make improvements are:

  • Review the process for identifying and recording significant events and complete a periodic review of significant events to identify trends.
  • Include information on the Parliamentary Health Service Ombudsman when formally responding to complaints.
  • Continue to review and monitor the National GP Patient Survey results to ensure improvement.
  • Review and make improvements disabled patient toilet facilities provided in line with the requirements of the Equality Act 2010.
  • Ensure an appropriate system is in place for the safe monitoring of blank prescriptions.
  • Continue to monitor infection prevention and control through audits across all premises.
  • Review the business continuity plan and ensure it meets current circumstances.

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