This practice is rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) - Requires improvement

We carried out an announced comprehensive inspection at Marisco Medical Practice on 28 March 2018. This was as part of our inspection program.

At this inspection we found:

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was an open and transparent approach for reporting and recording significant events.

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

• There was an active and effective patient group that was involved in facilitating a range of health promotion, welfare rights and advice services.

• The complaints system was not effective and did not provide a mechanism for capturing all complaints or to facilitate learning from complaints to be cascaded to staff.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

• There was no effective infection prevention and control process in place.

• The practice had not acted upon the advice of independent health and safety advisors and had failed to address and rectify a potentially serious patient safety issue.
• The systems in place to monitor and ensure staff received essential training relative to their job role was ineffective.
• The temperature of refrigerators were not effectively monitored to ensure the efficacy of stored medicines .

• Care and treatment was provided by dedicated and caring staff.

• Staff we spoke with told us that the absence of any minor injuries provision in the area impacted upon their everyday work when people turned up at the surgeries seeking help.

• Patient group directions did not meet the standard to allow nurses to administer medicines in line with the legal requirements.

• Feedback from patients showedthat appointment systems were not working well.

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

Please see the requirement notice section at the end of the report for more detail

The areas where the provider should make improvements are:

• Take steps to increase the availability of pre-bookable appointments.

• Undertake pro-active engagement with patients as a means of assessing patient satisfaction with the service with particular reference to access to clinicians.

• Update health and safety posters to show the correct contact details.

• Update the whistleblowing policy.

• Review the practice of recording complaints in patients’ clinical notes.

• Continue to monitor and assess patient views with regard to access to care and treatment and interactions with GPs and take action as appropriate.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice