This practice is rated as Good overall. (Previous rating July 2018 – Inadequate)

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? - Good

We carried out a comprehensive inspection on 24 July 2018 when we found patients were at risk of harm because practice systems to manage risk had not been followed and the governance of the practice was inadequate. Practice systems and policies to safeguard vulnerable patients were not comprehensive. There were insufficient staff to provide a good level of service to patients and information coming into the practice was not managed safely. There was evidence some patient consultation records were not sufficient to ensure patient safe care and treatment and the management of staff training was not comprehensive. Communication with staff, patients and other services was lacking; care plans were not routinely shared for vulnerable patients. There was little evidence of quality improvement work by the practice to drive improvements in service. Some staff reported they did not feel supported or valued and team morale was low.

We rated the practice as inadequate overall and the practice was placed into special measures.

At the end of July 2018, the practice provider changed from a partnership of two GPs to an individual GP. The practice registration with CQC was formally changed to this new provider in February 2019.

At this inspection we found:

• The practice had developed their systems to manage risk so that safety incidents were less likely to happen. Staff used significant incidents to improve processes and we saw evidence they were shared with staff at regular meetings.
• The staffing of the practice had been addressed. Patient safety and safeguarding systems were comprehensive and staff were able to carry out their roles and responsibilities safely in relation to these systems.
• 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. Quality improvement was embedded into practice.
• The quality of patient medical records was good enabling patient safe care and treatment.
• There was a new management overview of staff training and development. Staff training and development was supported with protected time and encouraged by managers.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Communications in the practice had been improved. Staff felt engaged in the running of the practice; they felt valued and supported and team morale was high.
• The governance of the practice had been strengthened and new systems and processes put in place to assure managers patient care and treatment was safe and effective.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Continue to review records of vulnerable patients to allow for all family and household members to be identified.
• Continue to improve the uptake of childhood vaccinations and immunisations.
• Implement the new process to offer timely reviews for patients with a new diagnosis of cancer.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

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