We carried out an announced comprehensive inspection at Pinehill Surgery on 23 January 2019. The inspection was brought forward from a later planned date due to intelligence received.

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 Inadequate overall. We have rated Safe, Caring and Well-led as inadequate and Effective and Responsive as Requires Improvement.

We rated the practice as Inadequate for providing safe, caring and well led services because:

• Leaders had been unable to sustain the previous level of quality achieved at our last inspection. There was no evidence of continuity.
• There was no ownership of quality improvement.
• Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.
• The practice had a clear vision, but it was not supported by a credible strategy.
• The practice culture did not effectively support high quality sustainable care.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• The practice did not involve the public, staff and external partners to sustain high quality care.
• There was little evidence of systems and processes for learning, continuous improvement and innovation.
• The practice did not have clear systems, practices and processes to keep people safe and safeguarded from abuse.
• The practice did not have systems for the appropriate and safe use of medicines.
• Feedback from patients was not always positive.
• The practice scored poorly in the 2018 GP survey and had not taken action to address the concerns raised by patients.

We rated the practice as Requires Improvement for providing effective and responsive because:

• The practice was unable to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
• The practice did not consistently organise and deliver services to meet patients’ needs, although there were some areas of good practice.
• People were able to access care and treatment in a timely way.

We rated all population groups, apart from people whose circumstances make them vulnerable as Requires Improvement overall because:

• The practice were unable to evidence regular meetings with external parties such as community palliative care team or health visitors.
• The practice had not met the 90% World Health Organisation (WHO) target for child immunisation and had not demonstrated actions taken to address this.
• The practice had not been responsive to the needs of older patients, patients with long term conditions, people whose circumstances made them vulnerable and people experiencing poor mental health by ensuring priority appointments, keeping registers and providing appropriate training for staff.
• There was not effective monitoring of high risk medicines.

We rated the population group working people whose circumstances make them vulnerable as Inadequate overall because:

• The practice was not actively identifying and monitoring vulberable people to keep them safe.

The areas where the provider must make improvements are:

• Care and treatment must be provided in a safe way for service users.
• Ensure that the premises used by the service provider are safe to use for their intended purpose.
• Ensure the proper and safe management of medicines.
• Assess the risk of preventing, detecting and controlling the spead of infections.
• Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of the Health and Social Care Act 2008.
• Recruitment procedures must be established and operated to ensure that the information specified in schedule 3 is available in relation to each person employed.

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

The areas where the provider should make improvements are:

• Review systems to identify vulnerable adults so they are regularly monitored.
• Monitor prescription requests to ensure that prescriptions for high risk medicines and medicines required to maintain positive mental health are collected in a timely way.
• Provide appropriate support for patients identified as carers.
• Carry out regular patient surveys and develop action plans as a result.

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. 

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pinehill Surgery on 13th September 2016. Overall the practice is rated as good.

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

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice overall patient list had reduced due to changes in the local area but had identified the new growth in patient numbers due to influx from other services. The staff level had not yet been reviewed to ensure the practice could continue to meet the needs of patients.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with a GP triage service available for making urgent appointments available the same day.
• The practice was well equipped to treat patients however access to the building requires a review for patients with a disability.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. However the meetings to discuss findings had been less often and minutes were not circulated as relevant to staff.
• Risks to patients were assessed and well managed. However a fire safety evacuation of staff and patients had not been undertaken since 2012.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However not all staff had received a regular performance review.
• There was a clear leadership structure. The practice proactively sought feedback from patients, which it acted on
• The provider was aware of and complied with the requirements of the duty of candour

However, there were areas of practice where the provider should make improvements

• Review the practice policy and procedures to ensure all are up to date for example, fire safety including fire evacuation drills.

• Ensure access to the practice is reviewed to enable patients with a disability to use the facilities independently.

• Review the staffing levels to meet the needs of the patients as the patient list grows.

• Hold regular practice meetings or other ways of communication, which are documented and available to all relevant staff

• Develop a planned annual audit programme for the practice to measure continuous quality improvement of their services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice