This practice is rated as inadequate overall. (Previous rating January 2016 – Good)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Inadequate

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Figges marsh Surgery on 2 October 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was carried out in response to concerns from monitoring information we hold. The inspection was carried out using our next phase inspection programme methodology.

At this inspection we found:

• The systems to keep people safeguarded from abuse were not clear.
• The practice did not have clear systems to manage risk to patients and staff including risks relating to recruitment, health and safety, security, infection control, medicines management and the home visiting system.
• Information systems including medical records and incoming correspondence management did not always ensure safe care and treatment was provided, in a timely way.
• Incident reporting systems were not operating effectively. The practice did not always identify, report and learn from incidents and safety alerts to improve their processes.
• Care and treatment was delivered according to evidence-based guidelines in most, but not all cases.
• The practice did not have clearly structured systems to monitor and support the effectiveness of the care it provided.
• Staff treated patients with compassion, kindness, dignity and respect although patients were not always involved in decisions about their care.
• The systems to support carers and those who had suffered a bereavement were not effective.
• Patients reported difficulty contacting the practice by telephone. Patients who visited the practice in person were more likely to secure appointments.
• Not all complaints were handled in line with the practice’s complaints policy and complaints information was not easily accessible to patients.
• The partners did not work cohesively to be able to deliver high-quality care; there was limited capacity to drive learning and improvement.
• The practice did not foster a culture where quality and safety was prioritised and staff did not always work as a team.
• Governance arrangements were unclear.
• There were limited systems to gather and utilise feedback from patients and staff.
  

The areas where the provider must make improvements as they are in breach of 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
• Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.

The areas where the provider should make improvements are:

• Review the systems for identifying and supporting carers and those who have suffered a bereavement.
• Review and improve access to appointments, including the ability for patients to contact the practice easily by telephone.

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.

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.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Figges Marsh Surgery on 28 January 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The majority of patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand, although information about translation services was not available to patients in the waiting room.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• There was a clear leadership structure and staff felt supported by management.
• Urgent appointments were usually available on the day they were requested, but some patients said that it was difficult to get through to the practice by telephone to make an appointment.
• The practice was receiving feedback through the GP Patient Survey and Friends and Family test, but no feedback was proactively sought from patients. There was no functional patient participation group.
• Risks to patients were generally well assessed and managed.

The provider should:

• Continue to review patient feedback on appointment availability and telephone access.

• Review quality improvement activity, making more active use of the patient participation group, audit and other evidence to monitor and improve services.

• Provide information for patients on translation services in the reception and/or waiting areas.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice