North Thoresby Practice

We carried out an announced comprehensive inspection at North Thoresby Practice on 29 November 2023. Overall, the practice is rated as Requires Improvement.

Safe - Requires Improvement

Effective - Requires Improvement

Caring - Good

Responsive - Requires improvement

Well-led - Requires Improvement

Following our previous inspection on 17 December 2015, the practice was rated as good overall and for all key questions.

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

Why we carried out this inspection

We carried out this comprehensive inspection in line with our inspection priorities as the practice had not been inspected since December 2015. During our inspection we reviewed our 5 key questions of safe, effective, caring, responsive and well led.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews using video conferencing.

• To ensure we gathered staff feedback we used a questionnaire which was given to staff electronically via email.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records remotely to identify issues and clarify actions taken by the provider.
• Requesting evidence to be submitted to us electronically from the provider.
• Interview with a care home covered by the practice.
• 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 found that:

• The arrangements for managing medicines did not always keep patients safe.
• They systems in place for managing historical safety alerts were not always effective.
• Patients with long-term conditions did not always have monitoring and reviews of their care and treatment in line with best practice guidance.
• Patients’ needs were not always assessed, and care and treatment were not always delivered in line with current legislation.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Leaders could not always demonstrate that they had all the skills to deliver high quality sustainable care.
• The overall governance arrangements required strengthening.

We rated the provider as Requires Improvement for providing safe services. This was because:

• The practice did not have all the systems and processes in place to keep people safe which included the management of medicines.
• Recruitment procedures required improvements.
• There was poor oversight and maintenance of the premises including fire, legionella, health, and safety.
• They systems in place for managing historical safety alerts were not always effective.

We rated the provider as Requires Improvement for providing effective services. This was because: -

• Patients were not always assessed, and care and treatment were not always delivered in line with current guidance.
• Some patients did not always receive medicine reviews in line with national guidance.
• There was no formalised performance monitoring of prescribing practices of non-medical prescribers or Additional Roles Reimbursement Scheme (ARRS) roles to ensure correct prescribing practices.
• The practice could not evidence that staff had completed training required for their role.
• Uptake rates for childhood immunisations and cervical screening rates were below national averages. Although we saw the practice were attempting to improve uptake rates the impact of the improvements had yet to be reflected in the data.

We rated the provider as Good for providing caring services.

We rated the provider as requires improvement for providing responsive services. This was because: -

• We recognise the pressure that practices are currently working under, and the efforts staff are making to maintain levels of access for their patients. At the same time, our strategy makes a commitment to deliver regulation driven by people’s needs and experiences of care. We saw that the practice was attempting to improve access for their patients this was not reflected in the GP patient survey data or other sources of patient feedback.

We rated the provider as requires improvement for providing a well-led service. This was because: -

• Leaders demonstrated that they had the capacity and skills, but work was required to improve systems and processes along with increased oversight of the whole practice and branch location.
• The overall governance arrangements were not effective in all areas.
• There were gaps in systems to assess, monitor and manage risks to patient safety.

We found three breaches of regulations. The provider must:

• Ensure care and treatment is provided in a safe way for service users.
• 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.

In addition, the provider should:

• Review recruitment arrangements to include all necessary employment checks for new staff,
• including written references.
• Continue to monitor and improve the uptake of childhood immunisations and cervical cancer screening for eligible patients.
• Consider patient leaflets on both sites to provide information to patients.
• Policies should be regularly reviewed to ensure their relevance and efficacy.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care