We carried out an announced comprehensive inspection at OHP-The Manor Practice on 14 January 2019 as part of our inspection programme.

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 have rated this practice as requires improvement overall due to concerns in providing safe, effective and well-led services. People with long-term conditions, families, children and young people as well as people experiencing poor mental health (including people with dementia) population groups were rated as requires improvement because the issues identified in effective impacted on these population groups. However, all other population groups was rated good.

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

• The practice operated a system to manage risk so that safety incidents were less likely to happen. However, when incidents did happen, the practice did not demonstrate a system to ensure learning to improve processes was disseminated at all levels of the practice.
• A sample of care records showed that patients prescribed high-risk medicines as well as other medicines which required closer monitoring were not routinely being reviewed in line with the practice protocol, which reflected national guidance. Clinicians were aware of medication review recording errors and were taking actions to strengthen the recording of medicine reviews to better evidence effective monitoring of medicines.
• Safeguarding systems, processes and practices were developed, implemented and communicated to staff.

We rated the practice as requires improvement for providing effective and well-led services because:

• Systems for monitoring repeat medicines was not operated effectively and did not demonstrate effective oversight. Practice based participation in care planning was not routinely being carried out.
• The 2017/18 Quality Outcomes Framework (QOF) performance for the practice showed variation in how the practice was performing compared to local and national averages. The practice was aware of areas such as exception reporting which required attention and were taking action to reduce the number of patients who were being exception reported unnecessarily.
• The practice carried out clinical audits to review the effectiveness and appropriateness of the care being provided.
• Leaders could show that they had the capacity and skills; however, unable to demonstrate how they transferred this to deliver high quality, sustainable care in some areas.
• The oversight of some governance arrangements were ineffective. For example, monitoring registration of clinical staff and medical indemnity insurance as well as the system for reporting and recording significant events.
• We saw little evidence of effective use of the systems and processes for supporting learning and continuous improvement following complaints.

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

• Staff dealt with patients with kindness and respect and involved them in decisions about their care. The 2018 national GP survey results was aligned with these views.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The provider should:

• Improve the identification of carers to enable this group of patients to access the care and support they need.
• Explore ways to maintain effective communication with the Patient Participation Group.
• Continue taking action to improve the uptake of childhood immunisations and national screening programmes such as cervical screening.
• Ensure systems and processes to support good governance in accordance with the fundamental standards of care is embedded into the practice.

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

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