The London Road Surgery

We carried out an announced focused inspection at The London Road Surgery on 20 January 2020, due to the length of time since our last inspection. The practice was rated as inadequate overall. Specifically, they were rated as inadequate for safe, effective and well-led. The good rating for caring and responsive remained from the previous inspection in 2015. The practice was placed into special measures.

As a result of findings at the January 2020 inspection, we took enforcement action against the provider and issued them with a warning notice for improvement.

We carried out an announced comprehensive inspection at The London Road Surgery on 5 November 2020. At this inspection we followed up on breaches of regulations identified at a our previous inspection.

We took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering how we carried out this inspection. We therefore undertook some of the inspection processes remotely and spent less time on site. We conducted staff interviews between 2 November and 5 November 2020 and carried out a site visit on 5 November 2020.

We had scheduled an inspection to follow up on the warning notice earlier this year although this was cancelled due to the COVID-19 pandemic. Therefore, we followed up on the warning notice at this inspection. We found that improvements had been made and the provider had met most of the requirements of the warning notice. However, there were still breaches of regulation and processes were not fully effective or embedded.

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.

We rated the practice as inadequate for providing well-led services because:

• While the practice had made some improvements since our inspection on 20 January 2020, it had not addressed all aspects of the Warning Notice.
• Leaders could not fully demonstrate that they had the capacity and skills to deliver high quality, sustainable care.
• While the practice had a vision, that vision was not supported by a credible strategy.
• The practice culture did not effectively support high quality sustainable care.
• The overall governance arrangements were ineffective and not fully embedded.
• The practice did not have effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• Due to the way that complaints and incidents were approached, effective learning and service improvement was limited.

We rated the practice as inadequate for providing safe services because:

• The practice did not have clear systems, processes and information for staff to keep patients safe.
• The system for assessing and managing risks was not effective
• There was limited evidence that the practice learned and made improvements when things went wrong.
• There was a lack of assurance that staff had all the information that they needed to provide safe care and treatment.
• Processes around the monitoring of patients prescribed high risk medicines and repeat medicines did not keep people safe.

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

• The system for ensuring staff were adequately trained was not fully effective.
• There was a lack of assurance that patients’ needs were assessed and delivered in line with current guidance.

These areas affected all population groups so we rated all population groups as requires improvement.

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

• Complaints were not always acknowledged in a timely manner and investigations did not always fully identify areas for service improvement and development.

These areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as good for providing caring services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

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.

(Please see the specific details on action required at the end of this report).

This service remains 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. 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 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.

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