This practice is rated as Good overall (previous ratings, April 2016 – Inadequate, December 2016 – Good).

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Garden Park Surgery on 28 November 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care they provided and ensured that care and treatment was delivered according to evidence- based guidelines.
• Feedback from patients was wholly positive. Patients praised the practice for providing an excellent service. Doctors and nurses were named individually as going the extra mile and giving exceptional care. Patients said that receptionists went out of their way to be helpful.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. The practice scored very highly on the National GP Patient Survey on questions relating to access.
• Staff told us they felt supported and engaged with managers. Staff and patients were involved in discussions and planning for the proposed merger with another local practice.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

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

We carried out a previous announced inspection of this practice on 29 April 2016. During the previous inspection we found patients were at risk of harm because the systems and processes in place were ineffective and were not implemented in a way that kept them safe. We identified significant concerns in relation to medicines management and infection control arrangements and breaches of legal requirements were found. We also placed the practice into special measures, as we rated the practice as inadequate in the questions ‘Is the practice safe, effective and well led?’

We undertook this announced comprehensive inspection on 6 December 2016 to check that the practice had improved and to confirm they now met legal requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Garden Park Surgery on our website at www.cqc.org.uk.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had made significant progress since the last inspection and had addressed all areas of concern. A new lead GP partner had been appointed and they had led the transformation work.
• We found improvements in the overall governance arrangements, clinical governance, leadership and clinical effectiveness.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• 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.
• Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure in place and staff felt supported by management. The practice proactively sought feedback from staff and patients, which they acted on.
• Staff throughout the practice worked well together as a team.

The area where the provider should make improvements is:

• Take steps to ensure remedial works identified during the legionella risk assessment are carried out within the appropriate timescales.

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

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 Garden Park Surgery on 29 April 2016. Overall the practice is rated as inadequate.

Our key findings were as follows:

• Patients were at risk of harm because the systems and processes in place were ineffective and were not implemented in a way that kept them safe. For example, we found significant concerns in relation to medicines management and infection control arrangements.
• There was insufficient evidence that the practice carried out assessments and treatment in line with relevant and current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines.
• The outcomes of patients’ care and treatment was not always monitored regularly. Clinical audits were not routinely carried out to improve care and treatment.
• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, when things went wrong, lessons learned were not communicated widely enough to support improvement.
• Staff had not all received all of the training necessary to carry out their roles effectively.
• 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.
• Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
• There was a leadership structure in place and staff felt supported by management. The practice sought feedback from staff and patients, which they acted on.
• Staff throughout the practice worked well together as a team.

The areas where the provider must make improvements are:

• Implement effective arrangements to assess the risk of, prevent, detect and control the spread of healthcare related infections.
• Ensure appropriate arrangements are in place for the proper and safe management of medicines; including ensuring all medicines are in date and fit for purpose, monitoring the temperatures of the refrigerators used to store vaccines and maintaining records of blank prescription form serial numbers.
• Ensure all medical equipment, such as needles and syringes in the practice is within expiry date and fit for purpose.
• Provide care and treatment in a safe way, including ensuring that a minor surgery log is maintained, consent to minor surgery is obtained and documented and clinical samples are sent for analysis following minor surgical procedures.
• Ensure that the quality and safety of services is assessed, monitored and improved, including the development of a continuous programme of clinical and internal audit.
• Ensure staff receive appropriate support, including appraisal and training relevant to their role.
• Ensure relevant pre-employment checks are carried out on staff, including those who act as chaperones.
• Put systems in place to check that clinical staff are registered with the appropriate professional body.

In addition, the provider should:

• Review the arrangements to enable patients to summon support to access the branch surgery.

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

Garden Park Surgery is a practice with four GP's, two practice nurses and clinical and administrative support staff. The practice offers a wide range of services and can refer patients on to other healthcare providers when necessary.

Patients told us that they were extremely happy with the care, support, treatment and service that they received from the practice. One patient said, "The doctors are great, I couldn't ask for anything more they have been great. I phoned this morning and got this appointment straight away." Another patient said, "They always explain everything." Other comments included, "I am a diabetic and find their clinics excellent" and "I have a say in my care, definitely".

We found that patients' privacy and dignity were respected and they were involved in decisions made about their care.

Care and treatment was planned and delivered in line with patients' needs.

Patients told us they felt safe when in receipt of care and we saw that the provider had measures in place to identify abuse and prevent abuse from happening.

There were effective systems in place to monitor and control the spread of infection. Patients received care in a clean and hygienic environment.

Appropriate checks were carried out before staff began work and patients were cared for by suitably qualified, skilled and experienced staff.