The Care Quality Commission
  • Doctor
  • GP practice

Guildhall Surgery Also known as Guildhall Surgery

Overall: Good read more about inspection ratings

65-69 Guildhall Street, Folkestone, Kent, CT20 1EJ (01303) 851411

Provided and run by:
Guildhall Surgery

All Inspections

19 October 2022

During a routine inspection

We carried out an announced comprehensive at Guildhall Surgery on 19 October 2022. Overall, the practice is rated as good.

We rated the following key questions as:

Safe - Good

Effective - Good

Caring - Good

Responsive - Good

Well-led - Requires improvement

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection.

Following our previous inspection on 25 February 2022 the practice was rated inadequate overall with a rating of inadequate for providing safe and well-led services. The practice was rated as requires improvement for providing effective services. As a result of the concerns identified, we issued two warning notices for breaches of Regulation 12: Safe care and treatment and Regulation 17: Good governance. We also issued two requirement notices for breaches of Regulation 13: Safeguarding service users from abuse and improper treatment and Regulation 19: Fit and proper persons employed. The practice was placed into special measures.

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

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 facilities.
  • 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:

  • Safeguarding processes had been reviewed and updated to operate more effectively and staff were trained to appropriate levels for their role.
  • The practice had improved their oversight of test results and these were now reviewed in a timely manner.
  • The practice had made improvements to its authorisations to administer medicines by Patient Group Directions.
  • The practice had improved the process for monitoring patients’ health in relation to the use of high-risk medicines.
  • The practice had reviewed the system to record, monitor and share learning from significant events.
  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • The practice had improved their systems and processes to keep clinicians up to date with current evidence-based practice.
  • 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 had a clear vision and credible strategy to provide high quality sustainable care.
  • Some of the systems and processes to support good governance and management were not operated effectively. In particular, the system in place for the summarisation of new patient notes was not effective, complaints responses did not consistently provide details of how to take further action if patients were not satisfied with the response and the practice had not ensured non-clinical staff vaccinations were held in line with national guidance.

We found a breach of regulations. The provider must:

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

In addition, the provider should:

  • Continue to improve the uptake of childhood immunisations.
  • Continue to improve the uptake of cervical screening.
  • Continue to take action to address patient feedback and improve access to the service.

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.

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

23 February 2022 and 25 February 2022

During a routine inspection

We carried out an announced inspection at Guildhall Surgery on 23 February 2022 and 25 February 2022. Overall, the practice is rated as inadequate.

Overall, the practice is rated inadequate. The three questions reviewed as a part of this inspection were rated as follows;

Safe - inadequate

Effective – requires improvement

Well-led – inadequate

Following our previous inspection on 10 March 2016, the practice was rated Good overall and for all key questions. The full reports for previous inspections can be found by selecting the ‘all reports’ link for Guildhall Surgery on our website at www.cqc.org.uk.

Why we carried out this inspection

We conducted a comprehensive inspection in response to risk identified.

We undertook this inspection at the same time as Care Quality Commission inspected a range of urgent and emergency care services in Kent and Medway. To understand the experience of GP Providers and people who use GP services, we asked a range of questions in relation to urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

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 and in person.
  • 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 short site visit to each of the locations.

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 inadequate overall and for all population groups.

We found that:

  • There was a lack of governance systems to provide global oversight of the actions of individuals and the service, leading to some risks not being identified or mitigated.
  • Discussions between staff needed to be formalised, actions assigned, outcomes monitored and learning shared and embedded into practice.
  • Improvements were required to ensure the safe prescribing and monitoring of patients with long term conditions.
  • Although staff were committed, conscientious and caring the provider failed to ensure staff had adequate training, supervision and employment checks.
  • The majority of patients who completed the Friends and Family Test would recommend the practice.
  • The practice had adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic which had an effect on the service..

We found four breaches of the regulations. The provider must:

  • Ensure care and treatment is provided to service users in a safe way.
  • Safeguard service users from abuse and improper treatment
  • Ensure systems and processes are established and operate effectively to ensure care and treatment is provided in a safe way to patients.
  • Ensure fit and proper persons are employed.

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

I am placing the service into 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 vary the provider’s registration 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.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

9 December 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr M A Hossain & Partners on 9 December 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

  • There was an open and transparent approach to safety and a system 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 the skills, knowledge and experience to deliver effective care and treatment.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Information about services and how to complain was available and easy to understand.

  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

  • The provider was aware of and complied with the Duty of Candour.

We saw areas of outstanding practice including:

  • The practice had worked with the local crisis drop-in team to support those people in the local community who were homeless or asylum seekers in vulnerable circumstances. The practice had registered such people as patients at the practice.

  • The practice worked collaboratively with a local rehabilitation centre to provide shared care for patients with drug and alcohol addictions and provided care for patients living in local Salvation Army apartments.

  • The practice provided specialised care to women and children living in a local women’s refuge.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice