We carried out an announced comprehensive inspection at Queens Road Surgery on 5 December 2018. This inspection was a follow up to a previous inspection on 25 April 2018, when the practice received a rating of requires improvement overall. At that time the practice was rated as good for providing effective, caring and responsive services; whilst they received a rating of requires improvement for providing safe and well led services. A breach of regulations was identified at that time. This inspection was carried out to review the changes and improvements the practice had implemented since their previous inspection, and to follow up on the breach of regulation identified at that time. Our inspection team was led by a CQC lead inspector, and included a GP specialist advisor.

Our judgement of the quality of care at this service is based on a combination of what we found when we inspected, information from ongoing monitoring of data about services as well as information from the provider, patients, the public and other organisations.

We have rated this practice as good overall, with the key question of are services responsive and all of the population groups rated as requires improvement.

We concluded that:

• The practice had reviewed their arrangements in relation to health and safety in the practice. A fire risk assessment had been completed and actions implemented. Fire drills were carried out in line with legal requirements and a legionella risk assessment had been completed, with identified actions implemented.
• Infection prevention and control arrangements had been revised and improved. Vaccine fridge monitoring processes were thorough, and childhood immunisation arrangements were appropriate.
• The practice had clarified their processes in relation to bullying and harassment and whistleblowing to enable staff to feel supported in raising concerns. Clear, confidential lines of reporting issues of concern had been developed and communicated to all staff.
• Practice systems for incident reporting were in place. We saw that lessons were learned and communicated to all staff.
• Care and treatment was delivered in line with up to date relevant evidence based guidance.
• Staff immunisation status had been reviewed, and arrangements put in place to ensure all staff were appropriately immunised.
• Systems for reviewing uncollected prescriptions were in place to optimise patient safety.

However, we also found that:

• There were challenges in relation to nurse recruitment. In addition, a number of key staff had recently indicated their intention to leave the practice.
• Patient feedback indicated that satisfaction with telephone access to the practice, and the experience of making an appointment was below local and national averages.

The areas where the provider should make improvements are:

• Continue to review and improve patient experience of telephone access and access to appointments.
• Continue to ensure arrangements are in place to provide appropriate cover for key staff pending permanent replacements being in post.
• Review and improve the arrangements in place for patients to be able to access a female GP if they wish to do so.

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

This practice is rated as Requires Improvement overall. Specifically we rated the practice as requires improvement for providing safe and well led services. The previous inspection, carried out on 21 April 2015 rated the practice as Good for providing safe, effective, caring, responsive and well led services.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Queens Road Surgery on 25 April 2018. We carried out this inspection as part of our inspection programme.

At this inspection we found:

• The practice had systems in place to report incidents and near misses. Lessons learned were shared, and changes to systems and processes were implemented when appropriate.
• Risk assessments relating to health and safety in the practice were not always completed in a timely way. We saw that a fire risk assessment was out of date and that fire drills were not carried out in accordance with government requirements. We also saw that a legionella risk assessment action plan had not been implemented.
• There were gaps in relation to systems and process relating to infection prevention and control, vaccine refrigerator monitoring and childhood immunisation management.
• Clinicians delivered care and treatment in line with up to date local and national evidence based guidance. They regularly reviewed the effectiveness and appropriateness of care provided. They benchmarked their performance in relation to prescribing patterns and other variables against other practices in the locality.
• The practice had a number of policies in relation to staff grievances, bullying and harassment and whistleblowing. Feedback we received from a number of sources indicated that these policies were not always implemented effectively.
• Staff training and induction systems were in place. We learned of examples where staff had been encouraged to develop in their role and enhance their skills.
• The provider had adapted their appointment system to offer a range of appointment options to accommodate routine and urgent appointments. Patients told us they were able to get appointments when they needed them, although not always with their GP of choice.
• Regular clinical and staff meetings were held, where key governance areas such as significant events and complaints were discussed.
• We heard of examples where staff had worked effectively with the multidisciplinary team to support and plan care for vulnerable patients.
• Staff involved and treated patients with compassion, kindness, dignity and respect.

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

• The provider must do all that is reasonably practicable to assess, monitor,manage and mitigate risks to the health and safety of patients who use services.

The areas where the provider should make improvements are:

• Effectively employ policies in relation to bullying and harassment, grievance and whistleblowing processes in order to provide staff at all levels with a voice within the practice.
• Review and improve staff immunisation screening in line with Department of Health recommendations.
• Review and improve systems for following up patients whose repeat prescriptions are not collected.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Queens road surgery on 21 April 2015. Overall the practice is rated as good.

We found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for older people, people with long term conditions, families, children and young people and the working age population.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Risks to patients were assessed and managed, including those relating to recruitment checks.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand. Complaints would be addressed in a timely manner and the practice endeavoured to resolve complaints to a satisfactory conclusion.

• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

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

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

When we inspected the service in October 2013 we found that appropriate checks were not undertaken before staff began work. We issued a minor compliance action which required the provider to ensure they became compliant with this outcome. After our inspection the practice manager wrote to us to tell us how they would improve the ‘Requirements Relating to Workers’ procedures and practices.

We inspected the outcome ‘Requirements Relating to Workers’ at Queens Road Surgery. The staff member we spoke with said they felt supported by the practice manager. The staff member said "It is lovely to work here, the staff get on and we all help each other out".

We found that the necessary improvements had been made to the practice. We also found improvements had been made to the way staff were managed within the GP surgery. The service had made substantial improvements which look to be sustainable.

As part of our inspection we spoke with six patients who used the service, five staff members; including a doctor, two practice nurses, a practice manager and reception staff.

We were told the practice had recently recruited a ‘Patient Liaison officer’ for two and a half hours a week. This was to encourage and enable people who used the service to be involved in how the service was run.

People expressed their views and were involved in making decisions about their care and treatment.

Staff had received abuse awareness training and procedures were in place to respond appropriately to allegation of abuse.

Appropriate recruitment checks were not in place prior to the employment of staff. We have judged this had a minor impact on people who used the service and have told the provider to take action.

People had their comments and complaints listened to and where appropriate, action had been taken.

We reviewed the information available to us about Queens Road Surgery on 12 April 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.