Archived: Stratford House Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sparkhill Surgery on 3 December 2015. 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 and poor outcomes because systems and processes were not in place to keep them safe and ensure they received the care they needed.

• Patients with long term conditions or repeat medicines did not always receive regular reviews. Nationally published data showed patient outcomes were low for many long term conditions.

• Robust systems were not in place to ensure effective multi-disciplinary team working took place so that the needs of some of the most vulnerable patients were understood and met.

• A large backlog in the processing of patient information meant there was a risk of important information about patient care being missed. Following our inspection the practice advised us they had worked with the local Clinical Commissioning Group to cleared this backlog.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. These were investigated and learning shared with staff.

• Feedback from patients about the service they received was mixed. The national patient survey rated the service in most areas below the national and CCG average. Patients found it difficult to access appointments and often experienced long waits to be seen.

• Governance arrangements provided a forum for important information to be shared with staff. However, we found that the practice did not manage all risks well for example those relating to infection control and unforeseen events. In the absence of the practice manager staff were also unable to find key policies and procedures when needed.

The areas where the provider must make improvements are:

• Ensure patients receive care and treatment that is appropriate to their needs and keeps them safe and has regard to current best practice guidance.

• Ensure that the patient information received is processed and acted on in a timely way.

• Establish effective working arrangements with other health and social care professionals in order to deliver a multi-disciplinary package of care to those with complex care needs.

• Establish effective systems for managing and mitigating risks to the service, for example unforeseen events and in relation to infection control.

• For relevant staff, establish effective systems for monitoring staff registration with their professional bodies to ensure it is kept up to date.

• Ensure patients are aware of the practice's complaints process so that they know how to raise their concerns.

• Review feedback received from patients such as the national GP patient survey to identify how patient access to services could be improved.

• Register the regulated activity of ‘Maternity and Midwifery Services’ with the Care Quality Commission.

The areas where the provider should make improvement are:

• Ensure effective cleaning schedules are in place for the medicines refrigerators to avoid the build up of frost.

• Ensure fire drills are routinely carried out so staff know what to do in the event of a fire.

• Maintain robust records for recording staff training to ensure staff are up to date.

• Support patients to understand and access the choose and book system.

• Provide suitable arrangements to enable patients to discuss sensitive or other matters in private away from the reception area.

• Ensure appropriate support and signposting is given to carers.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains 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. A notice has been served on this provider placing conditions on their registration which they must comply with. The conditions are the first two 'Must Improve' comments listed above.

The practice 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.

Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice