This practice is rated as inadequate overall.

Generating Healthcare Ltd are the registered providers of Orchard Surgery which was registered by the Care Quality Commission (CQC) on 14 December 2017. Orchard Surgery has not previously been inspected.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Inadequate

We carried out an announced inspection at Orchard Surgery on 23 October 2018 as part of our inspection programme.

At this inspection we found:

• The practice did not operate an effective system to manage risk so that safety incidents were less likely to happen. When incidents did happen, records we viewed did not show a full picture of actions taken and there was no evidence of shared learning.
• The practice did not operate effective systems to keep people safe and safeguarded from abuse. For example, staff who carried out chaperone duties did not have a disclosure and barring service check or a risk assessment to provide a clear rationale for this decision.
• The practice was unable to evidence that clinical and non-clinical staff received up-to-date safeguarding and safety training appropriate to their role.
• During our inspection, the practice was not equipped to deal with some medical emergencies. The practice recognised this on the day and obtained additional emergency medicines to enable staff to effectively respond to medical emergencies.
• Staff were unable to demonstrate that they routinely reviewed the effectiveness and appropriateness of the care they provided.
• Records showed that care and treatment was delivered according to evidence-based guidelines.
• Data from the 2016/17 Quality Outcome Framework showed performance was below local and national averages for some clinical indicators. The practice was aware of this and was taking action to improve the monitoring of patients’ treatment. The practice provided 2017/18 unverified data which showed improvements in patients’ care. Data for the 2017/18 QOF year published since our inspection confirmed this.
• Staff involved and treated patients with compassion, kindness, dignity and respect. The 2018 national GP patient survey results showed that satisfaction with how patients were treated and involved in their care and treatment were above local and national averages.
• Patients found the appointment system easy to use and completed Care Quality Commission comment cards as well a national GP patient survey results showed that they were able to access care when they needed it.
• A strong focus on continuous learning and improvement at all levels of the organisation was not evident. For example, the practice was unable to demonstrate shared learning or actions taken as a result of complaints and incidents.
• The practice did not operate a systematic approach to maintaining and improving the quality of service delivery. For example, there were several areas where the governance framework did not support the delivery of the strategy and oversight of some processes was not carried out effectively.

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.

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 FRCGPChief Inspector of General Practice