The Queens Road Partnership

This practice is rated as Requires improvement (Previous rating inadequate)

The key questions we inspected are rated as:

Are services safe? – Good

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 on 14 October 2019 at The Queens Road Partnership to follow up on concerns raised at our inspection on 21 February 2019. Following the February 2019 inspection, this practice was placed in special measures. We carried out a focused inspection in June 2019 to check compliance with enforcement action taken. The focused inspection was unrated. The published unrated report is available on our CQC website.

We carried out an announced comprehensive inspection on 14 October 2019 because the practice was in special measures and to check compliance with warning notices served following our February 2019 inspection.

At this inspection we inspected all six population groups and rated all population groups as requires improvement overall because of the issues regarding getting through to the practice by phone and access to appointments.

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 rated the practice as good for providing safe services because

At this comprehensive inspection we found:

• The practice had clear systems and processes to keep patients safe.

• At our last inspection not all risks to patient safety were managed well. At this inspection we found arrangements for identifying, monitoring and managing risks to patient safety had improved.

• At the time of inspection, the practice did not have appropriate medicines for the safe management of medical emergencies.

• The practice had reviewed the safety alert protocol and had started to implement a new system for managing safety alerts.
• Systems for monitoring patients prescribed high risk medicines were safe.

• The premises were clean and tidy, we saw evidence of actions taken to prevent and control the spread of infections.

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

• Childhood immunisation uptake rates were below the World Health Organisation (WHO) targets. Uptake rates for the vaccines given were below the minimum 90% target for three of four childhood immunisation uptake indicators. During our inspection, the practice shared unverified data from their population reporting dashboard which showed the practice had achieved the minimum target in these three areas.
• The practice was able to show that staff had the skills, knowledge and training to carry out their roles.

We rated all population groups as good in Effective, except Families, Children and Young People and Working age people which we rated as requires improvement because of the low childhood immunisation rates and low cervical screening uptake and the failure to take adequate action to improve them.

We rated the practice as good for providing caring services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• We received 31 patient comment cards. Patients described the staff as kind and helpful.

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

• The practice still scored below the national average in the National GP Patient Survey in relation to how easy it was to get through to someone at their GP practice on the phone. The practice was aware of this and had an action plan in place to address lower scoring areas in the NHS national patient survey. There was evidence to support waiting times on the phone had improved and the improvements had been maintained.

• Patient feedback showed patients could not always access care and treatment in a timely way. The practice monitored patient feedback and they had identified themes in patient feedback. The practice had a system in place to measure the impact improvements had made on patients’ access to care and treatment. However, these improvements were yet to be reflected in data from the national GP patient survey, which will be published in July 2020.

However these improvements were yet to be reflected in data from the national GP patient survey, which will be published in July 2020.

At this inspection we inspected all six population groups and rated all population groups as requires improvement in responsive (and therefore overall) because of the issues regarding getting through to the practice by phone and access to appointments which affects all population groups.

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

• The overall governance arrangements had improved. Leaders had put in place a system to measure the impact of the improvements made to the telephone system. There was evidence the practice had evaluated the impact of these changes to ensure improvements had been achieved and the quality of access to services had improved. For example, there was evidence from their telephone performance dashboard to support waiting times on the phone had improved.

• Although leaders had taken action in response to poor patient feedback, the practice had not yet taken reasonable steps to survey patients to check whether changes made to the telephone system and access to appointments had improved patient satisfaction

• Leaders had ensured they had oversight of systems and processes so that risks were managed effectively in the practice.
• The complaints procedure ensured patient needs were met and were in line with national guidance.
• There was an active patient participation group. There was evidence the practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients

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

• Continue to implement a programme to improve uptake of childhood immunisations.
• Encourage uptake of national cancer screening programmes.
• Continue to monitor patient satisfaction with telephone access and take further action if necessary.
• Continue to ensure policies and procedures are followed; for example, the emergency medicines protocol.

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

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

CQC carried out an announced comprehensive inspection of The Queens Road Partnership on 21 February 2019 as part of our inspection programme under Section 60 of the Health and Social Care Act 2008. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The practice was rated as inadequate overall with ratings of inadequate for providing safe and well-led services, requires improvement for effective and responsive services and good for providing caring services. As a result of the findings on the day of the inspection, we issued the practice with warning notices for breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

This was an announced focused inspection on 25 June 2019 to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements as detailed in the warning notices. The inspection report from our inspection on 21 February 2019 is available on our website.

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 found:

• The system for managing medicines had improved. The practice had systems in place for the safe management of medical emergencies. Equipment used by the service for providing care and treatment was safe.

• Risks associated with the premises had been assessed and had either been addressed or were in the process of being addressed.

• There were improvements in the use of the computer system to support the delivery of safe care and treatment. The provider had arranged staff training on the electronic patient record system to ensure it was used effectively.
• The provider had a system for managing written complaints; however, procedures for responding to patients did not always follow national guidance. There was no formal record kept of responses to verbal complaints. This concern was identified at our previous inspection.

• At the previous inspection arrangements for managing MHRA safety alerts were ineffective. At this inspection, we found the practice had a process for managing MHRA safety alerts; however, the provider still lacked oversight of how actions were identified and followed up.

• At the previous inspection there was no system to ensure staff appraisals were undertaken on a regular basis. At this inspection, staff files we reviewed showed staff had received an appraisal.

• There were processes in place for undertaking criminal record checks at the appropriate level for staff who require them.

• Governance arrangements had improved as the practice had reviewed and updated the policy framework covering most areas of operation; however, not all risk assessments had been translated into clear action. For example, actions identified from the fire risk assessment were not documented appropriately and there was no timeline of follow up recorded.

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.
• 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 support staff to implement searches on the patient record system.
• Monitor the improvements made and take action so that they are consistently embedded.
• Continue with work to upgrade the premises in light of the infection control audits.

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 The Queens Road Partnership, also on 21 February 2019. The practice was previously inspected on 15 December 2015, where they were rated as good for providing effective, caring, responsive and well-led services and good overall. The full comprehensive report of the 15 December 2015 inspection can be found by selecting the ‘all reports’ link for The Queens Road Partnership on our website at .

This inspection was an announced comprehensive inspection carried out on 21 February 2019 as part of our inspection programme. This report covers our findings in relation to the actions we told the practice they should take to improve as well.

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.