The Care Quality Commission
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  • GP practice

Archived: The Sollershott Surgery

Overall: Good read more about inspection ratings

44 Sollershott East, Letchworth Garden City, Hertfordshire, SG6 3JW

Provided and run by:
The Practice Surgeries Limited

All Inspections

28 March 2018

During a routine inspection

This practice is rated as Good overall. (Previous inspection 07/2017 – Inadequate)

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 undertook a comprehensive inspection of The Sollershott Surgery on 12 May 2016 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as inadequate for providing safe and well led services and was placed into special measures for a period of six months. We undertook a further announced comprehensive inspection of The Sollershott Surgery on 06 July 2017. This inspection was carried out following the period of special measures to see if improvements had been made and to assess whether the practice could come out of special measures. The practice continued to be rated as inadequate for providing safe and well led services and remained in special measures for a further period of six months. The full comprehensive reports on the May 2016 and July 2017 inspections can be found by selecting the ‘all reports’ link for The Sollershott Surgery on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 28 March 2018.

At this inspection we found:

  • Practice specific policies and procedures were in place, they were regularly reviewed and accessible to all staff, including locum and temporary staff.
  • Patients’ health was now monitored to ensure appropriate blood monitoring had taken place. The provider had implemented a rolling programme of audits of patients who were prescribed high-risk medicines.
  • The provider had identified a clinical lead for the practice and established a regular team of self-employed sessional GPs to provide continuity of care. Clinical meetings were now held in the practice.
  • The practice had developed an active patient participation group (PPG) who they engaged with to obtain views and concerns of the patient population.
  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. Incidents and learning were shared with the provider’s governance team to identify any trends and learning across the organisation.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The most recent published quality and outcomes framework (QOF) data showed the practice were below local and national averages overall and in many areas particularly for the monitoring of patients with long-term conditions and patients experiencing poor mental health (including those with dementia).

The areas where the provider should make improvements are:

  • Continue to monitor and ensure improvements to national GP patient survey results in all areas.
  • Continue to monitor the care and improve outcomes for patients particularly those with diabetes and patients experiencing poor mental health.
  • Consider ways to ensure staff engagement and satisfaction with their employment.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

6 July 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Sollershott Surgery on 12 May 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for The Sollershott Surgery on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 6 July 2017. The overall rating for the practice remains Inadequate.

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

  • There was a lack of visibility and oversight from the provider in relation to clinical leadership within the practice.
  • The provider relied on locum GPs to support the service. Patients we spoke with and comments made on the CQC comments cards indicated there was a lack of continuity of care. Locum packs were available to familiarise locum GPs with the practice and local area. However, we found these did not cover all areas, for example, safeguarding information was missing.
  • The system for checking the monitoring of high-risk medicines was not evident. Electronic patient records showed that some patients had not received appropriate blood monitoring.
  • Arrangements for safeguarding reflected relevant legislation and local requirements. Policies were accessible to all staff although they were not practice specific.
  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average in most areas. They were an outlier for mental health related indicators.
  • Results from the national GP patient survey, published July 2017, showed that patient’s satisfaction with how they could access care and treatment was below the local and national averages in some areas. However, there had been improvements in all areas from the previous year’s survey.
  • The practice had formed a patient participation group (PPG). There had been three meetings since the previous inspection, the most recent in January 2017 when The Practice Group had been commissioned to run the service.
  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • 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.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Urgent appointments were available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Routine appointment booking and repeat prescription requests could be made online. The practice had received recognition from NHS England for promoting online services. They had 19% of their patients who regularly used online services, which exceeded the national target of 10%.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients , for example implement systems and processes to ensure the safe prescribing of medicines.
  • Establish effective systems and processes to ensure clinical leadership and good governance in accordance with the fundamental standards of care. For example, provide sufficient visible clinical leadership to ensure there is effective governance and oversight of incidents and performance and continuity of care for patients and engage with the patient participation group (PPG).

The areas where the provider should make improvement are:

  • Ensure all policies are specific to the practice.
  • Continue to monitor and ensure improvements to national GP patient survey results in all areas.
  • Continue to monitor the care and improve outcomes for patients experiencing poor mental health.

This service was placed in special measures on 1 September 2016. Insufficient improvements have been made and further areas of concern have been identified so there remains a rating of inadequate for safe and well-led. 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 six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice