You are here

High Street Surgery Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 7 June 2019

We previously carried out an announced comprehensive inspection at the practice on 22 October 2014. The practice was rated as requires improvement overall and for providing safe and well led services. The practice was rated as good for providing effective, caring and responsive services. We carried out a focused inspection on 8 October 2015 and the practice was rated good overall and for providing safe services and requires improvement for providing well led services. We carried out an announced comprehensive inspection on 20 September 2017. The practice was rated as inadequate overall, requires improvement for providing safe services, inadequate for providing effective and well led services and good for providing caring and responsive services. As a result of the findings on the day of the inspection, the practice was issued with a warning notice on 13 October 2017 for regulation 17 (good governance) and was placed into special measures for six months. We carried out an announced comprehensive inspection on 12 April 2018. The practice had complied with the warning notice and were taken out of special measures. They were rated requires improvement overall, and for providing safe and well led services and good for providing effective, caring and responsive services. The full comprehensive reports on the 4 October 2014, 8 October 2015, 20 September 2017 and 12 April 2018 inspections can be found by selecting the ‘all reports’ link for High Street Surgery on our website at www.cqc.org.uk.

The practice is rated as

requires improvement

overall.

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

We carried out an announced comprehensive inspection at High Street Surgery on 17 April 2019. This inspection was to follow up on breaches of regulation identified at the previous inspection and to see if improvements made since the practice was taken out of special measures had been maintained.

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. At this inspection we found:

  • The required improvements had been made in relation to health and safety risk assessments and the implementation of fire safety recommendations.
  • Staff dealt with patients with kindness, compassion and respect and involved them in decisions about their care and treatment.
  • A carers lead had been appointed, who organised information and support to carers.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • Improvements had been made to the way the practice was led and managed. The leadership was open, and staff were listened to and involved in service developments. A patient participation group had been established and members were involved in improving the service.

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

  • Medicines and Healthcare products regulatory agency (MHRA) alerts were not always monitored to completion.
  • There was a cervical screening failsafe system in place, however, not all patients had been recorded on the system.

The practice is rated as requires improvement for providing effective services because two population groups, people with long term conditions and people experiencing poor mental health (including people with dementia) were rated as requires improvement. This was because:

  • The exception reporting data for the quality and outcome framework relating to long term condition and mental health indicators, was above the CCG and England averages. Although the practice excepted patients in line with QOF requirements, and some patients had had follow up telephone calls, a significant number of patients had not received the interventions. Some performance had declined since our last inspection.
  • Evidence based guidance was not always followed; we identified some patients on combinations of medicines which were not recommended.

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

  • The practice did not have an effective system for monitoring performance through accurate data, specifically related to the exception rates for the quality and outcomes framework data. This had been identified at previous inspections and although the unverified 2018 to 2019 data showed some exception reporting had reduced, it did not demonstrate a significant improvement. The practice had provided Ardens exception reporting data, although this did not correlate with the QOF exception reporting data. The practice advised they were not able to address this as they could not access the QOF data, however, this had not been acknowledged until we announced our inspection.
  • Effective processes were not in place to monitor and improve performance, in relation to childhood immunisation and cervical screening. Although the lead nurse audited the uptake of immunisation and wrote to and telephoned patients, the practice performance was below the World Health Organisation target of 90%.
  • Although improvements had been made to prescribing data, for example, the clinical pharmacist had reviewed patients prescribed three different hypnotic medicines, and subsequent audit had identified a decrease in the number of patients prescribed these medicines, the practice data for hypnotic prescribing continued to be significantly above the CCG and England averages.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.

The areas where the provider

should

make improvements are:

  • Continue to engage with the Clinical Commissioning group to improve their prescribing.
  • Continue work to improve childhood immunisation and cervical screening uptake rates.

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

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Requires improvement

Effective

Requires improvement

Well-led

Requires improvement
Checks on specific services

People with long term conditions

Requires improvement

Families, children and young people

Good

Working age people (including those recently retired and students)

Good

People experiencing poor mental health (including people with dementia)

Requires improvement

People whose circumstances may make them vulnerable

Good