Background to this inspection
Updated
9 March 2020
Ware Road Surgery moved into temporary premises at 42 Castle Street, Hertford, SG14 1HH in April 2019. The premises are shared with another GP practice. The provider of Ware Road Surgery is Generating Healthcare Ltd. Generating Healthcare Ltd is a Federation of 15 NHS GP practices in Hertfordshire which covers approximately 120,000 patients and is managed by a team of GPs as well as practice managers who have the responsibility for developing the organisation.
The contract to run Ware Road Surgery was awarded to Generating Healthcare Ltd from 1 April 2017. We did not visit any of the other locations as part of this inspection.
The practice is registered with the CQC to carry out the following regulated activities; diagnostic and screening procedures, surgical procedures, family planning, maternity and midwifery services and treatment of disease, disorder or injury.
Services are provided on an Alternative Provider Medical Services (APMS) contract (a nationally agreed contract) to approximately 4,472 patients. Patients at Ware Road Surgery are in the process of registering at neighbouring practices as the service is due to close on 31 March 2020.
The practice does not employ any GP partners or salaried GPs. The clinical team is led by a long-term locum GP and the practice has three regular locum GPs in total providing 13 sessions per week. There is one regular locum advanced nurse practitioner providing two sessions a week and two locum practice nurses. The practice employs a healthcare assistant, a practice manager, an office manager and nine administration and reception staff members.
The age of the practice population served is comparable to local and national averages. The practice has a slightly higher than average number of patients aged from zero to four years old and a slightly lower than average number of patients aged from 65 to 74 years old. The practice population is predominantly white British and has a black and minority ethnic population of approximately 5% (2011 census). National data indicates the area is one of low deprivation.
The Out of Hours service is provided by Herts Urgent Care and can be accessed via the NHS 111 service.
Updated
9 March 2020
We carried out an announced comprehensive inspection at Ware Road Surgery on 13 December 2018. Overall the practice was rated as requires improvement and requirement notices were issued.
The report from our inspection in December 2018 can be found by selecting the ‘all reports’ link for Ware Road Surgery on our website at www.cqc.org.uk.
We carried out an announced comprehensive inspection at Ware Road Surgery on 21 January 2020. This inspection was undertaken to follow up requirement notices we issued to the provider. We found the practice had not complied with the requirement notices previously issued.
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 requires improvement for the population groups.
We rated the practice as inadequate for providing safe services because:
- The practice did not have clear systems, practices and processes to keep people safe and safeguarded from abuse.
- The systems and process for the ongoing monitoring of infection prevent and control required strengthening.
- The practice did not have systems for the appropriate and safe use of medicines, including medicines optimisation.
We rated the practice as requires improvement for providing effective services because:
- The practice was unable to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
- There was no system of ongoing clinical and internal audit to monitor the effectiveness of clinical care.
We rated the practice as requires improvement for providing caring and responsive services because:
- The results from the latest National GP Patient Survey published in July 2019 showed the practice was performing lower than local and national averages for several indicators.
- Information about how to complain was not readily available at the practice.
We rated the practice as inadequate for providing well-led services because:
- The overall governance arrangements were ineffective.
- The provider did not have clear and effective processes for managing risk, issues and performance.
The areas where the provider must make improvements as they are in breach of a regulations are:
- Ensure care and treatment is provided in a safe way to patients.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
Please see the final section of this report for specific details of the action we require the provider to take.
I am placing this service in 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.
Special measures will give people who use the service the reassurance that the care they get should improve.
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