All inspections: Custom House Surgery - Care Quality Commission

We carried out an announced inspection at Custom House Surgery on 20 June 2022.

Overall, the practice is rated as Requires Improvement.

The ratings for each key question are:-

Safe - Good

Effective – Requires Improvement

Caring - Good

Responsive – Requires Improvement

Well-led - Good

Following our previous inspection on 20 October 2021, the practice was rated Requires Improvement overall. The key questions were rated Inadequate for providing a Safe service, Requires Improvement for providing an, Effective, Responsive and Well-led services and Good for providing a Caring service.

At the inspection we issued a breach of Regulation 17 (Good Governance) and 12 (Safe Care and Treatment) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Custom House Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

This comprehensive inspection was to review the improvements made by the provider in response to the breaches of regulation.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included: Completing clinical searches on the practice’s patient records system and discussing findings with the provider.
Reviewing patient records to identify issues and clarify actions taken by the provider.
Requesting evidence from the provider.
A site visit.

Our findings

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.
Information from the provider, patients, the public and other organisations.

We have rated this practice as Requires Improvement overall

We found that:

The practice had made significant improvements since the last inspection and had developed a good strategy to continue drive improvements.
The practice provided care in a way that kept patients safe and protected them from avoidable harm.
Patients received effective care and treatment that met their needs. However, child immunisations and cervical screening remained below the national target.
Staff dealt with patients with kindness and respect and involved them in decisions about their care.
The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way. However, further action was required to improve the practice performance regarding patient satisfaction.
The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We found one breach of regulations. The provider must:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

Improve whole practice communication to allow all staff member sto be aware of what is happening within the practice.
Conduct annual apprasials for all staff within the appropriate timeline.

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

We previously carried out an announced comprehensive inspection of Custom House Surgery on 20 October 2021. At that inspection, we found the practice was in breach of Regulation 12 Safe care and treatment of the Health and Social Care Act 2008. In line with the CQC’s enforcement processes, we issued a warning notice which required Custom House Surgery to comply with the regulations by 31 December 2021.

The Custom House Surgery is currently rated as requires improvement overall (inadequate for the key question of safe, and requires improvement for the key questions of effective, responsive and well-led, and good for the key question of caring).

The full report of the practice’s previous inspection can be found by selecting the ‘all reports’ link for Custom House Surgery on our website at www.cqc.org.uk.

We carried out this announced focused inspection on 14 February 2022 of the Custom House Surgery, to review compliance with the warning notice issues previously. We did not visit the location during this inspection. At this inspection we found the breaches of regulation in our warning notice had now been complied with. This report covers our findings in relation to those specific areas, is not rated, and does not change the current ratings held by the practice.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out remotely with consent from the provider and in line with all data protection and information governance requirements.

This included:

Conducting staff interviews using video and telephone conferencing
Completing clinical searches on the practice’s patient records system and discussing findings with the provider
Reviewing patient records to identify issues and clarify actions taken by the provider
Requesting evidence from the provider

Our findings

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 and other organisations

Following our methodology, we have not rated the practice at this inspection.

At the inspection on 14 February 2022, we found the provider had taken effective actions to address the breaches of regulation.

Appropriate clinical monitoring was in place for patients prescribed high risk medicines.
Systems of coding to identify patients with long term conditions such as diabetes had improved.
Patients with long term conditions were reviewed and signposted to preventative care where appropriate.

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

Continue to review and improve evaluation of improvement actions, to ensure improvements embedding and longer-term sustainability

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

We carried out an announced comprehensive inspection at Custom House Surgery on 20/10/2021. Overall, the practice is rated as Requires improvement.

Ratings for each key question:

Safe - Inadequate

Effective - Requires improvement

Caring - Good

Responsive – Requires improvement

Well-led – Requires improvement

Following our previous inspection on 30/11/2020 the practice was rated Requires improvement overall and rated Good for providing safe services but Requires improvement for providing effective, caring, responsive and well led services.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Custom House Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

This comprehensive inspection to follow up on breaches of regulations and covers our findings in relation to the actions we told the practice they should take to improve.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

Conducting staff interviews using video conferencing
Completing clinical searches on the practice’s patient records system and discussing findings with the provider
Reviewing patient records to identify issues and clarify actions taken by the provider
Requesting evidence from the provider
A site visit.

Our findings

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.

We found that:

Although there were some strong systems to manage risks to patients, there were some risks that were not well managed, for example, medicines management processes related to monitoring high-risk medicines.

The system of medicines reviews for patients with long term conditions required improvement. For example, we found evidence where the diagnosis was not correctly coded or documented in the patient record which meant some patients had not been reviewed or signposted to preventative care.

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

The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.

Childhood immunisation uptake rates were below the World Health Organisation (WHO) targets. Uptake rates for the vaccines given were below the target of 95% in five areas where childhood immunisations are measured.

The practice had not demonstrated it had an effective strategy to improve its performance for cervical screening which was lower than CCG and England averages.

There was evidence improvements made in listening to patients were reflected in the results of the 2021 GP National Patient Survey. Overall experience of the practice had improved from 50% (March 2020) to 59% (March 2021).

The provider had implemented systems and process in response to the findings of our previous inspection. However, the governance arrangements in place still required improvement especially in relation to identifying, managing and mitigating risks.

We found breaches of regulations. The provider must:

Ensure that care and treatment is provided in a safe way.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

Continue to implement a programme to improve uptake for cervical screening and childhood immunisations.
Take action to increase the number of carers identified, in order that they can provide support to these patients.
Improve compliance with policies and procedures; for example, the prescribing policy.
Continue to encourage patients to become members of the patient participation group.

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

We carried out an announced comprehensive inspection of Customs House Surgery on 30 November 2020.

The practice was last inspected on 10 October 2019 where we rated it as inadequate overall and placed the practice in special measures.

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.

At this inspection, we have rated the practice as requires improvement overall and requires improvement for all population groups.

At this inspection we have rated the practice as good for providing safe services because:

Following the previous inspection in October 2019 an electrical installation condition report was carried out on 24/03/20. The installation was deemed satisfactory.
The record of all staff absences was now managed on a cloud-based computer system which was proactively reviewed by the management team. Steps had been taken to increase staff numbers including the recruitment of two additional receptionists, two sessional GPs and a Nurse Practitioner.
There was now an effective system in place for managing test results which ensured they were acted upon in a timely manner in order to keep patients safe.

We rated the practice as requires improvement for providing effective services because:

Processes for ensuring baby checks were carried out in time had been improved, however the practice’s achievement for childhood immunisations and cervical screening remained below target, although this was based on the same published data as the previous inspection.
The practice’s achievement for some mental health indicators was below local and national averages but had improved since the previous inspection.
Performance data for patients with long term conditions had improved from the previous year and were now in line with local and national averages.

We rated the population groups of ‘Older people’, ‘People with long-term conditions’ and ‘People whose circumstances make them vulnerable’ as good for providing effective services. We rated the population group of ‘Families, children and young people’, ‘Working age people’ and ‘People experiencing poor mental health’ as requires improvement for providing effective services due to the low uptake for childhood immunisations and cervical screening and below average achievement for some mental health indicators.

We rated the practice as requires improvement for providing caring services because:

The practice’s GP patient survey (GPPS) results for 2020 remained below local and national averages for most questions relating to kindness, respect and compassion from clinicians.
The practice was aware of this and formulated an action plan to address these concerns which was still in progress.
We received positive feedback about the changes being made to address patient’s concerns through responses from the patient participation group (PPG), the practice’s own survey results and reviews we saw online. However, these improvements were yet to be reflected by the results of the national survey.

We rated the practice as requires improvement for providing responsive services because:

Although the practice’s results of the GP patient survey to questions about access to care and treatment remained below local and national averages the practice had taken positive steps to address this issue.
Staff we spoke with told us since the previous inspection there had been an increase in staffing (both clinical and non-clinical members) which had had a positive impact. This was reflected in the results of the practice’s own patient survey in November 2020 and recent reviews about the practice we saw online.
Whilst the practice was taking steps to address the access difficulties reflected by the GP patient survey and there was some evidence of positive feedback in feedback from the patient participation group (PPG) and online reviews about the practice, these improvements were yet to be reflected by the results of the GP patient survey.

These areas affected all population groups so we rated all population groups as requires improvement for providing responsive services.

We rated the practice as requires improvement for providing well led services because:

The partners had insight into the concerns highlighted at the previous inspection about the leadership failings at the practice and had taken steps to address these. Both partners had undergone leadership, coaching and mentoring courses since the previous inspection. One of the partners had completed a course to become a clinical supervisor and planned to become a GP trainer.
A new permanent practice manager had been employed and was able to effectively manage the day to day operations of the practice, leaving the partners to deal with the clinical matters and general oversight of the practice.
The CQC registration failings found at the previous inspection had since been resolved and one of the partners was now the Registered Manager. The financial management of the practice was now stable and all appraisals had now taken place.
The risk management processes had been reinforced and improved, including those relating to records security and test results.
However, whilst there was evidence of processes put in place to manage issues and performance, these had yet to prove effective in addressing concerns such as performance in childhood immunisations, cervical screening and patient’s experiences of the practice as reflected by the results of the GP patient survey.

The areas where the provider must make improvements are:

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).

The areas where the provider should make improvements are:

Continue to review and improve staffing requirements and take action to ensure sufficient availability to meet patient need.
Continue to review and improve clinical outcomes for patients experiencing poor mental health.

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

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

We carried out an announced comprehensive inspection of Custom House Medical, Teaching and Training Practice on 10 October 2019 as part of our inspection programme.

The service was inspected on 23 January 2018 and was rated as inadequate overall. The practice was placed in special measures. Requirement notices were issued in relation to breaches of regulation 12 (safe care and treatment), regulation 13 (safeguarding service users from abuse), regulation 15 (premises and equipment), regulation 17 (good governance), regulation 18 (staffing) and regulation 19 (fit and proper persons employed).

The service was again inspected on 12 September 2018 and was rated as requires improvement overall. A requirement notice was issued in relation to breaches of regulation 12 (safe care and treatment).

At this inspection we followed up on breaches of regulations identified at the previous inspection in September 2018.

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 inadequate overall.

We rated the practice as inadequate for providing responsive services because:

The practice’s GP patient survey (GPPS) results for 2019 were below local and national averages for questions relating to access to care and treatment, and all the results were lower than the survey results from 2018, despite practice staff telling us at the previous inspection in September 2018 that measures had been put in place to improve low scores around access.
Patient feedback indicated that it was very difficult to get through to the practice by telephone and to get an appointment.
Staff we spoke to said the practice was understaffed and that this has impacted upon patients.

These areas affected all population groups, so we rated all population groups as inadequate for providing responsive services.

We rated the practice as inadequate for providing well-led services because:

Staff reported that leaders were approachable, however leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.
There were weaknesses in the oversight of and accountability for governance from the GP partners, for example in terms of failing to register correctly with the CQC, with regards to the financial management of the practice and in relation to lack of appraisals for non-clinical staff.
The systems for managing risks were not consistently effective, as some risks has not been identified or promptly dealt with by the partners, for example in relation to records security and the management of test results.
There was a track record of the practice failing to comply with the regulations, as demonstrated at previous inspections in January and September 2018.

We rated the practice as requires improvement for providing safe services because:

Unsatisfactory electrical wiring, which had been tested in May 2018, had not been remedied.
There was not a proactive approach to managing staff absences.
The system for managing test results was ineffective and put patients at risk of harm.

We rated the practice as requires improvement for providing effective services because:

We rated the population group of ‘Families, children and young people’ as requires improvement due to some 6-8 baby checks being carried out outside of the appropriate timeframe and low childhood immunisation data.
We rated the population group of ‘People with long-term conditions’ as requires improvement as performance data for this group was below national averages.
Although we also found that the practice reviewed and monitored the effectiveness and appropriateness of the care and treatment it provided through clinical audits, and that staff had the skills, knowledge and experience to carry out their roles.

We rated the remaining population groups as good for providing effective services.

We rated the practice as requires improvement for providing caring services because:

The practice’s GP patient survey (GPPS) results for 2019 were below local and national averages for most questions relating to kindness, respect and compassion from clinicians.
Although the practice had carried out its own patient survey, the only action to address low scores relating to this area was to recruit additional permanent clinicians.
Some patients we spoke to during the inspection told us they do not feel involved in their 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).

The areas where the provider should make improvements are:

Improve the system for contacting and inviting patients for 6-8 baby checks to ensure they are carried out within the appropriate timeframe.
Continue to work to improve performance for childhood immunisations and caring for patients with long-term conditions.
Improve the arrangements for monitoring the work of the nurses, pharmacist and healthcare assistant and consider formal documented reviews of their consultations.

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.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as requires improvement overall. (Previous rating 01 2018 – Inadequate)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Custom House Medical Teaching and Training Practice on 12 September 2018. This inspection was carried under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions and to follow up on breaches of regulations identified during the inspection of 23 January 2018.

At this inspection we found:

The practice had made significant improvements since our previous inspection and although further improvement remains necessary, the practice is making progress to become compliant with the regulations.
The practice had taken steps towards stabilisation; there were now four partners and the practice management team better understood their roles and functions.
Most renovation work excepting the flooring had been completed satisfactorily.
We found most risks were now being identified, actioned and appropriate steps taken to mitigate harm to patients and other service users.
Improvements were needed in relation to high-risk medicines and infection control.
The practice now maintained various matrices to monitor staff training and other important human resources tasks.
Long term conditions clinical indicators such as QOF remained below CCG and national averages, however unpublished and unverified data demonstrated gains in areas such as diabetes and mental health.
Patient satisfaction surveys were now in line with local averages, however they remained below national averages; more time was needed to ascertain fully if the initiatives implemented to improve access were working and fully sustainable.
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.
There was a focus on continuous learning and improvement at all levels of the organisation.
Complaints management was effective, and responses demonstrated adherence to the Duty of Candour.

The areas where the provider must make improvements as they are in breach of regulations are:

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

The areas where the provider should make improvements are:

Introduce a system to monitor the pharmacist’s work.
Consider introducing a protocol for sepsis identification and how clinicians record vital signs in patient’s clinical notes.
Continue to take action to monitor low performing areas such as diabetes, mental health and patient’s satisfaction.

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

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Inadequate overall. (Previous inspection 14 December 2016 – Requires improvement)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Inadequate

Are services responsive? – Inadequate

Are services well-led? – Inadequate

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 – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those recently retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

We carried out an announced comprehensive inspection at Custom House Medical, Teaching and Training Practice on 23 January 2018. We inspected the provider as part of our inspection programme to follow up on areas we found the practice should improve at our previous inspection 14 December 2016.

At this inspection we found:

The practice had experienced significant changes in staffing , including practice management and a high turnover of GPs.
Premises improvement works were underway.
A broad range of clinical and patient satisfaction performance indicators were below local and national averages.
Risks to patients were not always assessed and well managed including premises, equipment, fire safety and infection control.
There were gaps in staff training and recruitment checks including safeguarding and references checks for clinical staff.
Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
Information about services and how to complain was available and easy to understand but limited improvement was made to the quality of care in response to concerns.
The practice did not have effective governance systems to ensure effective management of significant events and safety alerts, but was aware of and complied with the requirements of the duty of candour.

The areas of practice where the provider must make improvements are:

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

Ensure all premises and equipment used by the service provider are fit for use.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

Review arrangements for recording clinical audits.
Review arrangements for responding to patient feedback.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Custom House Medical Teaching and Training Practice on 14 December 2016. Overall the practice is rated as requires improvement.

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

Data showed patient involvement was low compared to the national average. For example, 69% of patients said the last GP they saw was good at involving them in decisions about their care compared to the CCG average of 74% national average of 82%.
QOF performance for long term conditions was below the national average particularly for diabetes and mental health.
The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.
Patients said they found it difficult to make an appointment.
Some patient said they did not find the PPG an open and transparent group and sought representation from a local advocacy group to take their views to the practice.
There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
Risks to patients were assessed and well managed.
Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
Information about services and how to complain was available and easy to understand. 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.
The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

Ensure the proper and safe management of medicines.
Improve GP patient survey results to ensure better patient satisfaction.
Improve QOF performance particularly for long term conditions.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

We spoke to staff including doctors, a nurse, administrative staff and two managers. We spoke to eight people who used the service and collected written feedback from nine people. On the day of our visit we attended the patient participation group meeting.

We found that staff were polite and respected the privacy and dignity of people who used the service. Doors were kept closed during treatment and confidentiality was maintained in the reception area.

Care was assessed and planned to meet individual preferences. One person told us that, 'Dr X is very good. He genuinely listens and supports the choices I make relating to my health."

Staff told us that they were supported by their line managers. We found that training was up to date or planned, appraisals were in place. Supervision was structured for trainee doctors however for administrative staff, supervision was not as structured. Staff were up to date with safeguarding training and were able to tell us how they would report any concerns to the named safeguarding lead.

There was an effective system in place to monitor quality of the care provided. We saw that regular feedback was sought from staff and people who used the service. Complaints were reviewed and actioned in a timely manner.

Custom House Surgery

All Inspections

20 June 2022

During a routine inspection

Remote Inspection

During an inspection looking at part of the service

20 October 2021

During a routine inspection

30 November 2020

During a routine inspection

10 Oct 2019

During a routine inspection

12 September 2018

During a routine inspection

23 January 2018

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)

14 December 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)

16 January 2014

During a routine inspection