Watercress Medical, Mansfield Park Surgery

We decided to undertake an inspection of Watercress Medical, Mansfield Park Surgery following our annual review of the information available to us. This inspection looked at the following key questions of:

• Are the services at this location effective?
• Are the services at this location responsive?
• Are the services at this location well-led?

The practice’s annual regulatory review did not indicate that the quality of care had potentially changed in relation to Safe and Caring. However, during the inspection, based on what we found on inspection, we decided to also inspect the key question of:

• Are the services at this location safe?

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. Due to the issues identified in the Effective domain, all population groups have been rated requires improvement as well.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm but evidence of nine patient group directions (PGDs) not being authorised was found on inspection.
• The practice’s response was quick and appropriately managed to identify the root cause of this oversight.
• We found evidence of two lapses in the security arrangements on the day of inspection. These were in relation to prescription stationery security and immunisation fridge security and were raised with the practice on the day.
• Since inspection, the practice had arranged a visit from an external security contractor on 10 January 2020. The practice reported it was in the process of revising its security arrangements throughout the premises.
• Patients received effective care and treatment that met their needs.
• The practice had an effective system to ensure its exception reporting rates were regularly below local and national averages.
• The practice’s non-medical prescribing practitioner acted within their scope of competency and attended clinical meetings.
• We saw evidence demonstrating staff were not fully compliant with the practice’s own training requirements and appraisals had not been completed in with the practice’s own policy.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The practice was looking into sourcing a hearing loop and information leaflets in alternative formats such as braille to support those patients with a hearing or visual impairment.
• Patients said the care they received at the practice was what they needed, and it was provided when they needed it.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvements are:

• Improve the accessibility to information for patients with impaired vision or hearing loss.
• Consider alternative ways of involving the patient participation group to gain patients’ perspective.

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