The Care Quality Commission
  • Doctor
  • GP practice

Archived: Drs Pearce and Trenholm Also known as Springmead Surgery

Overall: Inadequate read more about inspection ratings

Springmead Surgery, Summerfields Road, Chard, Somerset, TA20 2EW (01460) 63380

Provided and run by:
Drs Pearce and Trenholm

All Inspections

12 and 17 January 2023

During an inspection looking at part of the service

We carried out an announced comprehensive at Drs Pearce and Trenholm on 12 and 17 January 2023. Overall, the practice is rated as inadequate.

Safe - inadequate

Effective - inadequate

Caring - requires improvement

Responsive - inadequate

Well-led - inadequate

Following our previous focused inspection on 28 September 2021, we rated effective good. The ratings from the 2020 inspection carried forward which made the service good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Drs Pearce and Trenholm on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up concerns and in response to risk reported to us.

We inspected all key questions:

Safe

Effective

Caring

Responsive

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.
  • 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 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 found that:

  • Governance systems overall were ineffective, in particular but not limited to medicines management; health and safety; staff training and recruitment; and monitoring of care and treatment provided to patients,
  • There was a lack of leadership and staff were not appropriately supported to ensure care and treatment for patients was effective.
  • There was limited oversight to ensure patients’ needs were assessed and reviewed appropriately and monitored in accordance with guidance.
  • Staff did not benefit from regular supervisions and appraisals to ensure they were provided with opportunities to develop and had receive training necessary to carry out their role.
  • Patients were unable to access care and treatment in a timely manner, in particular access to face to face appointments was poor; and there were no effective procedures in place to promote continuity of care.
  • Staff were inconsistent with treating patients with kindness, respect and compassion. Feedback from patients was negative about the way staff treated people.
  • Staff helped patients to be involved in decisions about care and treatment, but this was not consistent.
  • The practice did not have clear systems, practices and processes to keep people safe and safeguarded from abuse.
  • The practice did not have a system to learn and make improvements when things went wrong. There was a lack of clarity in what constituted a significant event.
  • Complaints were not used to improve the quality of care.
  • There was no evidence of systems and processes for learning, continuous improvement and innovation.

We identified regulatory breaches within the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. They are Regulation 12 Safe care and treatment; Regulation 13 Safeguarding service users from abuse and improper treatment; Regulation 15 Premises and equipment; Regulation 16Receiving and acting on complaints; Regulation 17 Good Governance and Regulation 18 Staffing.

We sent a letter of intent of potential enforcement action to the provider outlining our concerns and requested an action plan detailing how they were going to meet these breaches. The provider did not provide an action plan in the set timeframe. We considered further enforcement action and consulted other stakeholders regarding the sustainability of the practice. When a service is rated inadequate overall we usually look to place them in special measures and take high level enforcement action.

During our contact with the provider and external stakeholders it became clear that the practice was unable to continue to operate. The provider made a decision to hand the contract back to the Integrated Care Board and cease operating the service. A closure date was set for 24 February 2023.

We did not take enforcement action, but continued to work with the provider and stakeholders to ensure that all patients registered at the practice were safely transferred to the care of other GP practices.

The practice duly closed on 24 February 2023 and all patients were registered with another GP practice in a planned way.

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 Hospitals and Interim Chief Inspector of Primary Medical Services

28 September 2021

During an inspection looking at part of the service

We previously carried out an announced comprehensive inspection at Drs Pearce and Trenholm in March 2020 as part of our inspection programme. We rated the practice as Good overall. We rated the practice Good for providing safe, caring, and well-led services and requires improvement for providing an effective service. You can read the full report by selecting the ‘all reports’ link for Drs Pearce and Trenholm on our website (www.cqc.org.uk).

We were mindful of the impact of the Covid-19 Pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the Covid-19 Pandemic when considering what type of inspection was necessary and proportionate. Whilst there were no breaches to regulation found at the previous inspection, there were areas where impreovements were needed in providing effective care. On 28 September 2021, we carried out a desk-based review to look at the effective key question to see whether improvements had been made.

We found that the practice had put some measures in place towards improving, however further improvements were required. We therefore rate the practice as requires improvement for effective.

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 effective as Good because:

We found that:

  • 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.
  • 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.
  • Quality improvement and monitoring had taken place to improve the uptake of cervical screening. The practice had taken action to ensure patients with long term conditions received effective treatment.

Whilst we found no breach to regulation the provider Should:

  • continue measures already taken to ensure that patients with schizophrenia, bipolar affective disorder and other psychoses have a comprehensive, agreed care plan documented in the record, and ensure that
  • patients diagnosed with dementia have their care plan reviewed in a face-to-face review in the preceding 12 months.

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

5 March 2020

During an inspection looking at part of the service

We carried out an announced focussed inspection at Drs Pearce and Trenholm on 5 March 2020 as part of our inspection programme, and as a follow up to our last inspection on 11 December 2018.

When we last inspected Drs Pearce and Trenholm on 11 December 2018 it was rated as Requires Improvement overall; Requires Improvement for providing safe, effective and well-led services and Good for providing caring and responsive services. All the population groups were rated as Good other than those for people with long-term conditions, working age people (including those recently retired and students), and people experiencing poor mental health (including people with dementia) which were rated as Requires Improvement.

A requirement notice was issued to ensure that care and treatment was provided in a safe way to patients, effective systems and processes were established to ensure good governance in accordance with the fundamental standards of care and that the provider ensures that changes to its registration details are notified to the CQC.

This inspection focused on the following key questions:

  • Are services safe?
  • Are services effective?
  • Are services well led?

Because of the assurance received from our last inspection, we carried forward the ratings for the following key questions:

  • Are services caring? (Good)
  • Are services responsive? (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.

We provided the practice with Care Quality Commission feedback cards prior to the inspection and we received eight completed cards. Patients were generally positive about the practice staff, their experiences, and the care and treatment they received.

We have rated Drs Pearce and Trentholm as Good overall.

We have rated Drs Pearce and Trenholm as Requires Improvement for providing effective services and Requires Improvement for the two population groups which includes people with long term conditions and People experiencing poor mental health (including people with dementia) because:

  • Quality and Outcomes Framework (QoF) clinical indicators were below local and national averages for people with long-term conditions, and people experiencing poor mental health (including people with dementia). Exception reporting was also below local and national averages for these indicators.
  • The practice participated in national health priority schemes and initiatives to improve the population’s health. However, there were variations in the uptake of national screening programmes. The practice demonstrated awareness of this and were taking some action to improve the uptake of cervical screening.

We have rated Drs Pearce and Trenholm as Good for providing safe and well led services, and Good for all population groups other than the two population groups which includes people with long term conditions and people experiencing poor mental health (including people with dementia) because:

  • At this inspection, we found all the areas of concern from the last inspection had been addressed and improved.
  • We found the practice had successfully coped with a significant change and re-organisation of the management team.
  • Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
  • The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided.
  • Staff had the skills, knowledge and experience to deliver effective care, support and treatment.
  • Staff worked together and with other organisations to deliver effective care and treatment.
  • There was compassionate, inclusive and effective leadership at all levels. This included working with and supporting the practice Patient Participation group (PPG).
  • The practice had a clear vision and set of values that prioritised quality and sustainability.
  • The practice had a culture that drove high quality sustainable care.
  • There were clear responsibilities, roles and systems of accountability to support good governance and management.
  • There were processes for managing risks, issues and performance.

Although we did not find any beaches of regulation at this inspection, we did see some areas where the provider should make improvements. These are:

  • Continue monitoring the uptake of cervical screening in line with national guidance.
  • Continue monitoring exception reporting and associated performance data to support patients with long term conditions and those experiencing poor mental health (including people with dementia).
  • Continue implementing the changes identified within the practice business plan.

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

11 December 2018

During a routine inspection

We carried out an announced comprehensive at Drs Harris, Hughes, Pearce, Trenholm and Tressider on 11 December 2018 as part of our inspection programme.

This practice is rated as requires improvement overall. (Previous rating November 2014 – Good).

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

The area of effective impacted upon the population groups of long term conditions and people experiencing poor mental health (including people with dementia) and was rated requires improvement. The population groups of older people, families, children and young people working age people (including those recently retired and students) and people whose circumstances may make them vulnerable, as good.

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

  • The practice did not have clear systems and processes to keep patients safe, this included aspects of management of health and safety, fire safety and prescription paper security.

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

  • The practice did not have good oversight to ensure patients with some long-term conditions and those experiencing poor mental health (including people with dementia) needs were met.
  • There were gaps in clinical supervision and appraisal of staff.

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

  • There were gaps in information to show that there were adequate governance systems to support that it is a safe and well led service. This included records for recruitment, employment and supervision of staff, maintenance and administration of the service.
  • The provider had not made the CQC aware of changes to its registration status or made appropriate applications to amend its registration with CQC in a timely way.

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 practice had systems to respond to risks or concerns such those raised as significant events or complaints so that concerns were less likely to reoccur. When significant events and complaints were raised, the practice learned from them and improved their processes.
  • The practice had some systems that reviewed the effectiveness and appropriateness of the care it provided. Staff ensured that care and treatment was delivered according to evidence-based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients had mixed experiences about the telephone and appointment system some found it easy to use and reported that they could access care when they needed it others didn’t.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

  • The provider must continue to review the safe storage and handling of prescription stationery.
  • The provider must continue with implementing an effective programme to ensure that patients with mental health needs and dementia have the necessary reviews and care plans in place to meet those needs.
  • The provider must continue with developing good governance systems including record keeping, to support that it is a safe and well led service. This included records for recruitment, employment and supervision of staff, maintenance and administration of the service.
  • The provider must continue with the development of the overarching health and safety management including fire safety.
  • The provider should ensure that the CQC is informed and changes made to its registration.

The areas where the provider should make improvements are:

  • The provider should continue with appropriate safeguarding training in line with current guidance for administrators who handled safeguarding information at the practice.
  • The provider should continue with developing a central oversight of staff’s immunisation status to ensure that staff and patients were protected from the spread of infection.
  • The provider should review emergency medicines for insertion of contraceptive devices, in line with national guidance.
  • The practice should continue to proactively identify carers.
  • The provider should continue to monitor cervical smear screening to meet Public Health England screening rates.
  • The provider should introduce a planned programme clinical audit.

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

Please refer to the detailed report and the evidence tables for further information

12 November 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

Drs Harris, Hughes, Pearce, Trenholm and Tresidder (Known as Springmead Surgery) was inspected on Wednesday 12 November 2014. This was a comprehensive inspection.

Springmead Surgery provides a service to approximately 6,500 patients in the Somerset town of Chard. The practice provides primary medical services to a diverse population age group.

The team at Springmead is composed of five GP partners. GP partners hold managerial and financial responsibility for running the business. In addition there were three registered nurses, two health care assistants, a practice manager, and additional administrative and reception staff.

Patients using the practice also had access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

We rated this practice as good.

Our key findings were as follows:

There were systems in place to address incidents, deal with complaints and protect adults, children and other vulnerable people who used the service. Significant events were recorded and shared with multi professional agencies. There was evidence that lessons were learned and systems changed so that patient care is improved.

There were systems in place to support the GPs and other clinical staff to improve clinical outcomes for patients. According to data from the Quality and Outcomes Framework (QOF), outcomes for patients registered with this practice were equal to or above average for the locality. QOF is the annual reward and incentive programme detailing GP practice achievement results, Patient care and treatment was considered in line with best practice national guidelines and staff were proactive in promoting good health.

The practice were pro-active in obtaining as much information as possible about their patients which affect health and wellbeing. Staff knew the practice patients well, were able to identify people in crisis and were professional and respectful when providing care and treatment.

The practice planned its services to meet the diversity of its patients. There were good facilities available. Adjustments were made to meet the needs of the patients and there was an improving appointment system in place which enabled good access to the service.

The practice had a clear vision and set of values which were understood by staff and made known to patients. There was a clear leadership structure in place. The team structure had changed in recent months with the introduction of new practice manager and nursing team. Many of the issues we identified had already been recognised and were being addressed to make sure quality and performance was monitored and risks are identified and managed.

There were also areas of practice where the provider should make improvements.

The provider should ensure that:

  • All clinical staff receive training in the Mental Capacity Act (2005).
  • Policies and procedures should be kept up to date and made available to all staff.
  • A health and safety audit should be repeated and action points from it taken forward.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice