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Inspection Summary

Overall summary & rating


Updated 21 June 2019

We carried out an announced comprehensive inspection at Stanhope Surgery on 12 April 2018. The practice was rated as requires improvement for providing responsive services, and the overall rating for the practice was good. We carried out an announced focused inspection at Stanhope Surgery on 22 May 2019, to check on the areas previously identified as requiring improvement.

The full comprehensive report on the April 2018 inspection can be found by selecting the ‘all reports’ link for Stanhope Surgery on our website at

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 good overall and good for all population groups. (Previous rating 04/2018 – Good).

We found that:

  • The practice organised and delivered services to meet patients’ needs.
  • Patients found the appointment system easy to use. Patient comments and information collected by the practice demonstrated that patients were able to access care when they needed it.

At our previous inspection in April 2018 we told the provider they should make improvements in the following areas:

  • Complete the review of the immunisation status of non-clinical staff and ensure a documented process is in place to evidence compliance.
  • Ensure an effective system is in place for monitoring uncollected prescriptions.
  • Continue to encourage patients to attend national screening programmes for breast cancer screening.
  • Ensure all complaints are managed in accordance with recognised guidance and contractual obligations for GPs in England.

At our inspection in May 2019 we found:

  • The provider had established and embedded a staff immunisation policy. All staff members had a record of vaccinations in place, which were in line with national guidance. The practice had a system to ensure this was reviewed on a regular basis.
  • The practice had introduced a protocol for reviewing uncollected prescriptions. From the sample of documents we viewed, we found uncollected prescriptions were being managed appropriately. All uncollected prescriptions were monitored and clinically reviewed by a GP. Patient records were updated accordingly.
  • The practice continued to encourage patients to attend national screening programmes. Information was displayed in the practice and on the practice website. The practice sent text messages out to patients to encourage uptake and a named GP took a lead role in telephoning patients who had failed to attend their screening appointment.
  • The practice had reviewed their complaints policy. From the sample of documents we viewed, we found complaints received by the practice were being managed in accordance with the recognised guidance. The practice responded to all complaints within the set timescales and included information about the Parliamentary and Health Service Ombudsman as standard.

Whilst we found no breaches of regulations, the provider should:

  • Continue to monitor and ensure improvements to national patient survey results in all areas below average including access to the practice by telephone and the availability of appointments.
  • Continue to encourage patients to attend national cancer screening programmes.

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

Inspection areas










Checks on specific services

People with long term conditions


Families, children and young people


Older people


Working age people (including those recently retired and students)


People experiencing poor mental health (including people with dementia)


People whose circumstances may make them vulnerable