This practice is rated as inadequate overall. (Previous rating 06/2018 – Inadequate)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Lister House Surgery on 18 and 19 June 2018. The overall rating for the practice was inadequate and the practice was placed into special measures for a period of six months. Warning notices were served in relation to breaches identified under Regulation 12 Safe care and treatment and Regulation 17 Good governance. We completed an announced focussed inspection on 22 August 2018 to check on the areas identified in the warning notices and to see if sufficient improvements had been made regarding these. The practice had taken some of the actions needed to comply with the legal requirements. However, there was still concerns with the leadership and governance of the practice. A further warning notice was served in relation to the breaches identified under Regulation 17 Good governance and a requirement notice was issued for the breaches identified under Regulation 12 Safe care and treatment.

The full comprehensive report on the June 2018 inspection and the focussed report for the August 2018 inspection can be found by selecting the ‘all reports’ link for Lister House Surgery on our website at .

This announced comprehensive inspection on 14 February 2019 was carried out following the period of special measures to ensure improvements had been made and to assess whether the practice could come out of special measures.

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

• Non-clinical members of staff were sometimes asked to chaperone although they had not all received training for the role.
• Information in the consultation and treatment rooms regarding the treatment of sepsis was not relevant to GP practices.
• We found some irregularities with repeat prescriptions.
• There were no audits or checks in place for the prescribing of controlled drugs or medicines with the potential for misuse.
• A record of blank prescription forms received by the practice was not kept.
• There was no identification on the plug of the vaccine fridge to show it should not be removed.

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

• The practice’s performance on quality indicators for patients with long term conditions was below local and national averages in some areas.
• The practice had not achieved the 90% target for children aged two who had received immunisation for measles, mumps and rubella.
• The practice’s uptake for cervical screening was 61%, which was below the 80% coverage target for the national screening programme.
• Although the practice had developed some measures, there were high exception reporting rates for some quality indicators.

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

• Feedback from patients on the CQC comments cards, the practice’s own survey and the NHS Friends and Family Test was all positive regarding the care received.
• The practice had provided responses and actions for the areas where they scored below the local and national averages in the national GP patient survey published in August 2018.

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

• Patients were not always able to access care and treatment in a timely way.
• The 2018 GP patient survey showed the practice scored lower than others locally and nationally for questions regarding appointment booking.

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

• There remained concerns with the leadership in the practice. There had been four different practice managers in post in the past year.
• There had been changes to the GP partnership but there were no formal agreements in place to support this. Updates to the CQC registration had not been made.
• The GPs and the practice manager had little knowledge of the performance data used and did not proactively take actions to achieve optimum results.

These areas affected all population groups so we rated all population groups as requires improvement, except for working age people and people experiencing poor mental health which were rated as inadequate in effective and therefore rated as inadequate overall.

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.

The areas where the provider should make improvements are:

• Continue to identify and support carers.
• Make improvements to cancer detection and screening rates.
• Continue to improve the uptake of immunisations for measles, mumps and rubella given to children aged two years.
• Continue to look at ways and implement identified actions to improve the levels of patient satisfaction. Particularly in relation to consultations and appointment booking at the practice.

This service was placed in special measures in August 2018. Insufficient improvements have been made such that there remains a rating of inadequate. Therefore, the service will remain 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.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection of Lister House Surgery on 22 August 2018. This inspection was undertaken to follow up on warning notices we issued to the provider in relation to Regulation 12 Safe Care and Treatment and Regulation 17 Good Governance.

The practice received an overall rating of inadequate at our inspection on 18 and 19 June 2018 and this will remain unchanged until we undertake a further full comprehensive inspection within six months of the publication date of the initial report.

The full comprehensive report from the June 2018 inspection can be found by selecting the ‘all reports’ link for Lister House Surgery on our website at .

Our key findings were as follows:

• The practice had taken some of the actions needed to comply with the legal requirements. However, there was still concerns with the leadership and governance of the practice. The breakdown in the professional relationship between the individual GP partners had not been resolved.
• Fire safety and Legionella risk assessments had been completed. However, identified actions had not been taken. There were no risk assessments in place for the control of substances hazardous to health (COSHH).
• There had been no infection prevention and control (IPC) audits completed so areas that required attention had not been identified.
• Significant events were now identified and reported on with lessons learnt identified and shared with staff.
• There was a system in place to manage safety alerts and Medicines and Healthcare products Regulatory Agency (MHRA) alerts received by the practice. However, a log of actions taken was not kept.
• Practice policies and procedures were all in the process of review. Essential policies were in place. For example, for safeguarding, whistleblowing and business continuity. However, the practice safeguarding lead was not identified in the policy.
• All staff had received a disclosure and barring check (DBS).
• Processes had been strengthened for managing test results and communications from secondary care so recommended actions had been completed. However, blood test results were not always documented in the patient computer record.
• There was a process in place for the use of Patient Specific Directions (PSDs).
• The practice had started to make plans to form a PPG. There was a link on the practice website for patients to fill in a form expressing their interest. The practice had completed their own patient surveys.
• A system of staff appraisals and one-to-ones had been implemented. All job descriptions had been reviewed and a formal induction process was in place for new staff.
• The complaints policy had been reviewed. Complaints were handled in accordance with the recommended guidance.

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.

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 focused inspection at Lister House Surgery on 4 November 2015. This was to check that improvements had been made following the breaches of legal requirements we identified from our comprehensive inspection in November 2014.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lister House Surgery on our website at www.cqc.org.uk.

Our key findings on this focused inspection were that the practice had made improvements since our previous inspection and were now meeting regulations that had previously been breached. Specifically:

• Systems were in place to identify and respond to concerns about the safeguarding of adults and children.
• The practice appeared clean and infection control processes were adhered to.
• Systems were in place and adhered to for the appropriate management of medicines.
• Systems were in place to ensure all applicable staff members received a criminal records check and that the required information was available in respect of the relevant persons employed.
• Appropriate arrangements were in place to deal with emergencies.
• Staff were supported by programmes of appraisal and essential training relevant to their roles.
• A process was in place to ensure patients’ capacity to consent was assessed in line with the Mental Capacity Act (2005). The process for documenting consent for specific interventions was well adhered to.

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 inspection of Lister House Surgery on 11 November 2014. This was a comprehensive inspection under Section 60 of the Health and Social Care Act (2008) as part of our regulatory functions. The practice achieved an overall rating of requires improvement. This was based on the safe and effective domains and six population groups we looked at achieving the same requires improvement rating.

Our key findings were as follows:

• Patients reported adequate access to the practice. Appointments, including those required out of normal working hours or in an emergency were available.
• Systems were in place to identify and respond to concerns about the safeguarding of adults and children.
• We saw patients receiving respectful treatment from staff. Patients felt that their privacy and dignity was respected by courteous and helpful staff.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

Ensure there are procedures in place for dealing with emergencies such as a business continuity plan which, if they arose, would be likely to affect the provision of services.

Ensure staff are trained in and aware of the processes used for safeguarding and obtaining patient consent, which may include details of the Mental Capacity Act (2005).

Ensure that systems designed to assess the risk of and to prevent, detect and control the spread of infection are fully implemented and audited.

Ensure a coordinated approach to medicines management and that all medicines are within their expiry dates and stored correctly.

Ensure adequate recruitment procedures are in place including completing the required background checks on staff.

Ensure staff receive appropriate supervision and appraisal.

In addition the provider should:

Ensure that information about how to make a complaint is readily available and accessible to patients.

Ensure there is a system to demonstrate staff have read and understood the practice’s policies and procedures.

Ensure there are adequate methods used to receive, action and respond to patient feedback.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with seven patients during our inspection. They gave us positive feedback about the practice and the staff. One person said, “I have been coming here since the 70’s so I must think it is OK.” People told us the service had improved recently. We were aware during 2013, that the service had identified a problem and a member of the administrative staff had left as a result. We were also aware that the practice had worked hard to ensure that policies and procedures that had not previously been available, had been put in place.

Patients with long term conditions were being monitored. The GPs were in the process of risk assessing the practice population to ensure they had identified the actions needed to reduce, amongst other things, the possibility of some patients being admitted to hospital unnecessarily.

Information was clearly displayed throughout the surgery for people using the service, including a variety of health promotion information. This was available in other languages as necessary. A touch screen facility enabled people to announce their arrival.

We observed the staff were friendly and welcoming. A member of the staff team said, “We all work together, we are like one big family.” Staff confirmed they felt well supported by each other and the GP partners.

The practice had a complaints procedure which ensured complaints were dealt with appropriately. However at the time of our visit this was not on display for people using the service to refer to.

This practice is rated as inadequate overall. (Previous rating April 2015 – Good)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires Improvement

Are services responsive? – Inadequate

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Lister House Surgery on 18 and 19 June 2018. The inspection was carried out in response to concerns raised regarding the leadership at the practice. There were also concerns shared specific to the supervision and training of staff, the management of correspondence from other care providers including test results, governance processes and access to care and treatment.

At this inspection we found:

• Significant concerns in the leadership and governance of the practice. There had been a breakdown in the professional relationship between the individual GP partners and some practice staff.
• The process for identifying significant events was not followed. We found that no significant events had been identified or reported on for two years.
• There was no system in place to manage safety alerts and Medicines and Healthcare products Regulatory Agency (MHRA) alerts received by the practice.
• Policies in place were not practice specific and many were overdue a review. This included policies for safeguarding children and vulnerable adults. There were no policies in place to cover whistleblowing or business continuity.
• Appropriate staff checks were made prior to recruitment. However, a disclosure and barring check (DBS) was missing for a member of the nursing team.
• There had been no infection prevention and control (IPC) audits completed so areas that required attention had not been identified.
• Staff morale was low and there had been recent resignations which left some of the remaining staff fulfilling more than one role.
• There was an inconsistent approach to managing test results and communications from secondary care which lead to some recommended actions not completed.
• There was not a process in place for the use of Patient Specific Directions (PSDs).
• There were no up to date risk assessments in place for the control of substances hazardous to health (COSHH), Fire Safety, Legionella, Health and Safety or Infection Prevention and Control.
• There was a lack of patient engagement. There was no patient participation group (PPG), no patient surveys had been completed and no actions taken in response to the national GP patient survey. The NHS friends and family test (FFT) was done via the practice website but there was no analysis of the results.
• Processes for providing staff with the development they needed were lacking. There had been no staff appraisals in the previous two years. New staff who had joined the practice in the previous two years had not received a formal, documented induction and there were no contracts or job descriptions available for these staff. Some staff were carrying out roles that they were not qualified or trained to do. For instance, members of the nursing team had completed medicine reviews that they were not qualified to do.
• The complaints policy was overdue a review. Not all complaints were handled in accordance with the recommended guidance.
• Feedback from patients on the CQC comments cards was generally positive.
• Feedback from a local care home that the practice was aligned to was positive. The home commented that the practice was responsive to requests for home visits.

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.
• Act in accordance with the Duty of Candour

The areas where the provider should make improvements are:

• Ensure clinical waste is stored securely.
• Continue to identify and support carers.
• Consider how to respond to GP patient survey results.

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