This practice is rated as requires improvement overall. (Previous rating August 2017 – Inadequate)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? - Good

We previously carried out an announced comprehensive inspection at Old Road West Surgery on 15 August 2017. Overall the practice was rated as inadequate and was placed into special measures.

We issued warning notices in respect of identified issues and found arrangements had significantly improved when we undertook a follow up inspection of the service on 5 February 2018. The details of these can be found by selecting the ‘all reports’ link for Old Road West Surgery on our website at

Following this inspection, the provider appointed a new Partner and made an application to CQC to change their CQC registration from a registered individual to a registered partnership. The application was supported by the CCG and was in transit when the newly appointed Partner resigned and the provider reverted to their previous legal entity.

We therefore conducted an announced comprehensive inspection on 29 November 2018 to check the practice has met the requirements of the regulations and re-evaluate the decision for placement into special measures.

At this inspection we found:

• The practice had significantly improved its formal systems to underpin how significant events, incidents and concerns were monitored, reported and recorded.
• The practice had made significant improvements and had clear systems to manage risk so that safety incidents were less likely to happen. For example, infection prevention and control and fire safety procedures.
• The practice had significantly improved its systems for the appropriate and safe handling of medicines.

• The practice's disease registers had been embedded and now contained all the relevant patients presenting with the clinical condition.
• The practice had systems for sharing information with staff and other agencies. However, care plans were not always accessible.
• Patient records for those requiring mental health checks, did not always contain evidence of physical health checks documented.
• Care and treatment was planned and delivered in a coordinated way.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Planned changes had been conducted to their appointment system to ensure it was meeting patients’ needs.
• The practice had improved its system for handling complaints and concerns. However, acknowledgment response times when the practice manager was absent needed addressing.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Most patients we spoke with found the appointment system easy to use and reported that they could access care when they needed it. However, national GP patient survey results did not reflect this.
• Governance arrangements had significantly improved to ensure they were always sufficient and effectively implemented.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure that care and treatment is provided in a safe way for service users.

The areas where the provider should make improvements are:

• Continue to monitor and ensure the system for recording the use of local anaesthetic is effective.
• Continue with their plan to improve how carers are identified and offered support.
• Improve the system for acknowledging the receipt of complaints in the practice managers absence.
• Continue to monitor and carry out their plan to address low national GP patient survey results.

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

We carried out an announced comprehensive inspection at Old Road West Surgery on 15 August 2017. Overall the practice was rated as inadequate and was placed into special measures. Practices placed in special measures are inspected again within six months of publication of the last inspection report.

A breach of the legal requirements was found because care and treatment was not being provided to patients in a safe way and the practice had not assessed the risks to the health and safety of service users. Where risks had been identified these had not been mitigated. Additionally, the practice did not have systems or processes established and operating effectively to assess, monitor and improve the quality and safety of the services provided.

As a result, the provider was not assessing, monitoring and improving the quality and safety of the services provided and mitigating the risks related to the health, safety and welfare of service users and others. Therefore, Warning Notices were served in relation to Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

• Regulation 12

• Regulation 17 Good Governance.

Following the comprehensive inspection, we discussed with the practice what they would do to meet the legal requirements in relation to the breach and how they would comply with the legal requirements, as set out in the Warning Notices.

We undertook this announced focused inspection on the 5 February 2018, to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 15 August 2017. The practice was not rated as a consequence of this inspection, as the practice is in special measures. It will be inspected again, with a view to assessing the practice’s rating when the timescale for being placed into special measures has passed.

This report only covers our findings in relation to those requirements. The full comprehensive report on the August 2017 inspection can be found by selecting the ‘all reports’ link for Old Road West Surgery on our website at www.cqc.org.uk

Our key findings were as follows:

• The practice had improved its formal systems to underpin how significant events, incidents and concerns were monitored, reported and recorded. However, further improvements were still required.

• There were systems, processes and practices to minimise risks to patient safety. However, further improvements were still required in order to help ensure all risks identified were actioned.

• The system to keep all clinical staff up to date and check their understanding of current evidence based guidance and standards, had improved.

• The practice's disease registers had been established and now contained all the relevant patients presenting with the clinical condition. However, these were a work in progress and required further embedding.

• Improvements had been made to help ensure that staff had the skills and knowledge to deliver effective care and treatment.

• The practice had improved how they shared the information with the out of hours provider.

• Care and treatment was planned and delivered in a coordinated way.

• The practice had improved how they obtained consent from patient's consent for minor surgery.

• An assessment had been conducted of their appointment system to ensure it was meeting patients’ needs.

• The practice had improved its system for handling complaints and concerns. However, further improvements were still required to help ensure complainants were responded to appropriately.

The practice had made improvements to its overarching governance framework. However, further improvements were still required in order to help ensure they were always effective.

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

Importantly, the provider must:

• Ensure care and treatment is provided in a safe way to patients.

• Ensure systems and processes to ensure good governance in accordance with the fundamental standards of care are effective.

In addition the provider should:

• Improve the daily checklist proforma for cleaning schedules.

• Improve policies in the locum induction pack to ensure they are up to date.

• Improve the way in which staff are involved with the development of practice specific policies.

• Improve staff development in order to ensure they are aware of their roles and responsibilities.

• Improve the management of complaints to help ensure they are processed effectively.

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 Old Road West Surgery on 15 August 2017. Overall the practice is rated as inadequate.

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

• There was no established and effective system to ensure the safe management of medicines.
• The practice was tidy but some areas of the premises required repair. The practice had not conducted an annual infection prevention control audit. Checklists were completed with staff confirming cleaning had been undertaken. However, there were no detailed cleaning schedules to show where, when and how items were cleaned.
• There were insufficient procedures for assessing, monitoring and managing risks to patient and staff safety.
• The practice had insufficient arrangements in place to respond to emergencies and major incidents. Best practice guidance had not been followed.
• We found some of the practice’s disease registers had not been validated to include the relevant patients with medical conditions. Therefore, the Quality and Outcome Framework data was not representative of the care and treatment provided to some of the practice’s patients.
• The practice did not provide evidence of clinical audits having been conducted and used to inform quality improvement.
• There was no induction pack for the locum GPs defining roles and responsibilities. Some clinical staff had not received annual appraisals, but we found evidence of them accessing appropriate training and personal development opportunities.
• Administrative staff had not received specific training and clinical oversight to screen and prioritise clinical information.
• Patients were not routinely offered the convenience of choose and book services. This was left to the discretion of the clinician.
• The practice had identified 0.5% of their patient list to be carers.
• Patients we spoke with reported difficulties making an appointment. The practice did not demonstrate an understanding of their population profile. They had not conducted an assessment of their appointment system and whether it was meeting their patients’ needs.
• Information about how to complain was available. Complaints were investigated and responded to appropriately. However, we found no evidence of learning or sharing of outcomes with staff and other stakeholders.
• The lead GP had a vision of how they intended services to be provided.
• Changes to personnel had left roles vacant and the risks associated with this had not been addressed.

The areas where the provider must make improvement 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 improvement are:

• Employ a consistent approach to choose and book services for the convenience of patients.
• Improve the identification of carers.
• Improve the identification of learning from complaints.

On the basis of the ratings given to this practice at this inspection. I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice