We carried out an announced comprehensive at Drs Harris, Hughes, Pearce, Trenholm and Tressider on 11 December 2018 as part of our inspection programme.

This practice is rated as requires improvement overall. (Previous rating November 2014 – Good).

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

The area of effective impacted upon the population groups of long term conditions and people experiencing poor mental health (including people with dementia) and was rated requires improvement. The population groups of older people, families, children and young people working age people (including those recently retired and students) and people whose circumstances may make them vulnerable, as good.

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

• The practice did not have clear systems and processes to keep patients safe, this included aspects of management of health and safety, fire safety and prescription paper security.

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

• The practice did not have good oversight to ensure patients with some long-term conditions and those experiencing poor mental health (including people with dementia) needs were met.
• There were gaps in clinical supervision and appraisal of staff.

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

• There were gaps in information to show that there were adequate governance systems to support that it is a safe and well led service. This included records for recruitment, employment and supervision of staff, maintenance and administration of the service.
• The provider had not made the CQC aware of changes to its registration status or made appropriate applications to amend its registration with CQC in a timely way.

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.

At this inspection we found:

• The practice had systems to respond to risks or concerns such those raised as significant events or complaints so that concerns were less likely to reoccur. When significant events and complaints were raised, the practice learned from them and improved their processes.
• The practice had some systems that reviewed the effectiveness and appropriateness of the care it provided. Staff ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients had mixed experiences about the telephone and appointment system some found it easy to use and reported that they could access care when they needed it others didn’t.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• The provider must continue to review the safe storage and handling of prescription stationery.
• The provider must continue with implementing an effective programme to ensure that patients with mental health needs and dementia have the necessary reviews and care plans in place to meet those needs.
• The provider must continue with developing good governance systems including record keeping, to support that it is a safe and well led service. This included records for recruitment, employment and supervision of staff, maintenance and administration of the service.
• The provider must continue with the development of the overarching health and safety management including fire safety.
• The provider should ensure that the CQC is informed and changes made to its registration.

The areas where the provider should make improvements are:

• The provider should continue with appropriate safeguarding training in line with current guidance for administrators who handled safeguarding information at the practice.
• The provider should continue with developing a central oversight of staff’s immunisation status to ensure that staff and patients were protected from the spread of infection.
• The provider should review emergency medicines for insertion of contraceptive devices, in line with national guidance.
• The practice should continue to proactively identify carers.
• The provider should continue to monitor cervical smear screening to meet Public Health England screening rates.
• The provider should introduce a planned programme clinical audit.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

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

Letter from the Chief Inspector of General Practice

Drs Harris, Hughes, Pearce, Trenholm and Tresidder (Known as Springmead Surgery) was inspected on Wednesday 12 November 2014. This was a comprehensive inspection.

Springmead Surgery provides a service to approximately 6,500 patients in the Somerset town of Chard. The practice provides primary medical services to a diverse population age group.

The team at Springmead is composed of five GP partners. GP partners hold managerial and financial responsibility for running the business. In addition there were three registered nurses, two health care assistants, a practice manager, and additional administrative and reception staff.

Patients using the practice also had access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

We rated this practice as good.

Our key findings were as follows:

There were systems in place to address incidents, deal with complaints and protect adults, children and other vulnerable people who used the service. Significant events were recorded and shared with multi professional agencies. There was evidence that lessons were learned and systems changed so that patient care is improved.

There were systems in place to support the GPs and other clinical staff to improve clinical outcomes for patients. According to data from the Quality and Outcomes Framework (QOF), outcomes for patients registered with this practice were equal to or above average for the locality. QOF is the annual reward and incentive programme detailing GP practice achievement results, Patient care and treatment was considered in line with best practice national guidelines and staff were proactive in promoting good health.

The practice were pro-active in obtaining as much information as possible about their patients which affect health and wellbeing. Staff knew the practice patients well, were able to identify people in crisis and were professional and respectful when providing care and treatment.

The practice planned its services to meet the diversity of its patients. There were good facilities available. Adjustments were made to meet the needs of the patients and there was an improving appointment system in place which enabled good access to the service.

The practice had a clear vision and set of values which were understood by staff and made known to patients. There was a clear leadership structure in place. The team structure had changed in recent months with the introduction of new practice manager and nursing team. Many of the issues we identified had already been recognised and were being addressed to make sure quality and performance was monitored and risks are identified and managed.

There were also areas of practice where the provider should make improvements.

The provider should ensure that:

• All clinical staff receive training in the Mental Capacity Act (2005).

• Policies and procedures should be kept up to date and made available to all staff.

• A health and safety audit should be repeated and action points from it taken forward.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice