Schoolacre Road Surgery Also known as Schoolacre Surgery

This practice is rated as Requires improvement overall. (Previous rating February 2018 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We first carried out an announced comprehensive inspection at Schoolacre Road Surgery in February 2015 where the practice was rated as good overall. As part of our inspection programme the practice was then inspected in February 2018 and rated as requires improvement overall. As a result, we issued requirement notices as legal requirements were not being met and asked the provider to send us a report that says what actions they were going to take to meet legal requirements. The full comprehensive report of all previous inspections can be found by selecting the ‘all reports’ link for Schoolacre Road Surgery on our website at 

This inspection was an announced comprehensive inspection carried out on 19 September 2018 to check whether the providers had taken action to meet the legal requirement’s’ as set out in the requirement notices. The report covers our findings in relation to all five key questions and six population groups.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• A sample of care records showed that patients prescribed high-risk medicines as well as other medicines which required closer monitoring were being managed in line with the practice protocol, which reflected national guidance. However; during our inspection, staff we spoke with did not demonstrate the appropriate skills and knowledge to enable them to carry out searches using the clinical system to gather information. Following our inspection, the practice sent us information which demonstrated that the CCG medicines team had gathered information from the clinical system to support the management of medicines.
• The practice carried out audits to review the effectiveness and appropriateness of the care it provided. There were plans in place to revisit clinical audits to see whether changes made had resulted in improvements to patient outcomes.
• Staff were aware of national guidelines and ensured that care and treatment was delivered according to evidence- based guidelines.
• The 2016/17 Quality Outcome Framework (QOF) performance for the practice was above local and national averages in several areas. However, exception reporting was above local and averages in some clinical areas. The practice was aware of this and taking action to improve compliance with QOF protocol.
• Staff involved and treated patients with compassion, kindness, dignity and respect. Results from the July 2017 national GP patient survey showed that the practice scored above local and national averages in a number of areas. Data from the 2018 national GP patient survey indicated that patients after action remained positive in a number of areas.
• Date from the 2018 national GP patient survey indicated that patients were less satisfied with appointment times; however, were positive about the appointment type and experience of making an appointment.
• There was a focus on continuous learning and improvement at all levels of the organisation when managing complaints and incidents.
• The practice had improved areas of their governance framework to support a systematic approach to maintaining and improving service delivery and patient care. We saw that improvements were ongoing in areas such as managing safety alerts; monitoring the effectiveness of systems to support medicines management and the monitoring of clinical audits.

The areas where the provider must make improvements are:

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

The areas where the provider should make improvements are:

• Continue taking action to improve the uptake of childhood immunisations and national screening programmes such as cervical screening.
• Continue reviewing and analysing patient comments and feedback.
• Continue taking action to identify carers.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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

This practice is rated as required Improvement overall. (Previous inspection February 2015 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) - Requires Improvement

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. However, assessments to mitigate risks in the absence of Disclosure and Barring Service (DBS) checks had not been carried out.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines.

• Data such as QOF exception reporting rates showed areas where exception reporting was above local averages. However, the practice was aware of areas where performance was below local and national averages; and taking steps to improve. For example, improving the uptake of cervical screening, childhood immunisations and maintaining up to date disease registers.

• Staff involved and treated patients with compassion, kindness, dignity and respect. Results from the July 2017 national GP patient survey showed that the practice scored above local and national averages in a number of areas. Completed Care Quality Commission comment cards were also positive about the services provided.

• Results from the national GP patient survey showed patients did not always find the appointment system easy to use and patients were not always able to access care when they needed it. However, completed CQC comment cards we received during our inspection were more positive.

• The practice took action to improve patient satisfaction; however, staff were unable to demonstrate whether actions carried out resulted in improvements in the experience of people accessing the service.

• The practice worked with community services to ensure that vulnerable groups in the community were not excluded from accessing quality care. For example, staff worked closely with a local service that provided support for people facing problems with drug and alcohol dependency. Over the past 12 months, 11% of patients engaged in a shared care programme successfully completed a community detox.

• There was some focus on continuous learning and improvement at all levels of the organisation. Staff we spoke with verbally described learning from complaints.

• In some areas, there were responsibilities, roles and systems of accountability to support governance and management arrangements. However, oversight of systems and processes to manage areas such as safety checks, the identification of trends following incidents; responding to performance issues, monitoring training needs and reducing some risks was not effective.

The areas where the provider must make improvements are:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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

The areas where the provider should make improvements are:

• Continue to review the health and safety risk assessments and areas for improving the building.

• Continue exploring measures to improve the uptake of cervical screening and childhood immunisations.

• Establish a process for analysing complaints in order to identify trends and continue exploring measures to improve patient satisfaction in areas such as access.

• Continue considering reasonable adjustments and arrangements to support patients who may need extra support to access the services, such as patients with physical impairments whilst awaiting relocation.

• Review mental health data to ensure clear understanding and reasons for high exception reporting.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice