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Inspection carried out on 3 July 2019

During a routine inspection

We carried out an announced comprehensive inspection at The Saltscar Surgery in January 2019. The overall rating for the practice was requires improvement. We made this judgement in January 2019 because arrangements in respect of; incident reporting processes, infection prevention and control, systems of assurance and overarching governance needed to be improved. The full comprehensive report on the January 2019 inspection can be found by selecting the ‘all reports’ link for The Saltscar Surgery on our website at www.cqc.org.uk.

This inspection was undertaken following as an announced comprehensive follow-up inspection on 3 July 2019. Overall the practice is now rated as good.

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.

Our key findings were as follows:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Staff were aware of current evidence-based guidance. Staff had been trained and had the skills and knowledge to deliver effective care and treatment.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw one area of outstanding practice:

The practice had a proactive approach to safeguarding

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We saw evidence of effective inter-agency working with regard to safeguarding. Some non-clinical staff had been trained to safeguarding level three and undertaken some additional training about specific vulnerabilities within safeguarding, for example; coercive behaviours and vulnerable, exploited, missing and trafficked (VEMT). Using their additional training, these members of staff, under the support and supervision of the lead GP, prepared reports for safeguarding strategy meetings and case conferences. We saw evidence of multi-agency case discussions, SAFER referrals (a referral for concern developed by the Tees wide local safeguarding board) and follow-up of outcomes. The practice had implemented the ‘Think Child’ concept into its care and treatment of families. The practice had applied the theoretical learning from safeguarding training, to real situations with patients, and could demonstrate successful outcomes where significant risks had been reduced for those patients, as a direct result of action by the practice (including appropriate professional challenge). Lessons learned from serious case reviews had been considered and applied, when the practice was acting on information of concern.

We have rated this practice as good overall and good for all population groups.

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

  • Continue to complete some outstanding medication reviews and improve the system for coding patients who have had a medication review.
  • Carry out regular searches of patients of child-bearing age who are prescribed certain long-term medicines.

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 carried out on 9 January 2019

During a routine inspection

We carried out an announced comprehensive inspection at The Saltscar Surgery on 9 January 2019 as part of our inspection programme.

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, and good for all population groups.

We found that:

The practice needed to make improvements to some systems that kept patients safe and protected them from avoidable harm.

Patients received effective care and treatment that met their needs.

Staff dealt with patients with kindness and respect and involved them in decisions about their care.

The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The way the practice was led and managed needed improvement, in order to deliver high-quality, person-centre care.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.
  • 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).

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection carried out on 9 April 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out this comprehensive inspection on 9 April 2015.

Overall, we rated this practice as good.

Our key findings were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed.
  • The practice provided a good standard of care, led by current best practice guidelines.
  • Patients were treated with dignity and respect.
  • The buildings were clean.
  • The practice provided effective care and support to people in vulnerable circumstances, such as those with dementia or learning difficulties.
  • The practice had an active Patient Participation Group who worked collaboratively with the practice to improve services and information for patients.

However, there were also areas of practice where the provider needs to make improvements.

In addition the provider should:

  • Ensure that all risks to patients who used services were assessed and monitored to ensure patients were kept safe. This should include ensuring that legionella testing takes place and the medicines in the GP’s bags are within date and safe to use.
  • Ensure that appropriate checks through the Disclosure and Barring Service and training records are kept up to date for all those working in the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice