We carried out an announced comprehensive inspection at The Connaught Square Practice on 15 June 2017. The overall rating for the practice was Requires Improvement. The full comprehensive report on the 15 June 2017 inspection can be found by selecting the ‘all reports’ link for The Connaught Square Practice on our website at www.cqc.org.uk.

This inspection, on 23 August 2018, was an announced comprehensive inspection to confirm that the practice had carried out their plan to meet the requirements that we identified in our previous inspection on 15 June 2017. This report covers our findings in relation to those requirements and any improvements made since our last inspection. The practice is now rated as Good overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

At this inspection we found:

• The practice had addressed the findings of our previous inspection in respect of the management of patient safety alerts, safeguarding, infection prevention and control, medicine management and clinical protocols.
• There were systems in place to safeguard children and vulnerable adults from abuse and staff we spoke with knew how to identify and report safeguarding concerns.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice had systems in place to ensure care and treatment was delivered according to evidence-based guidelines.
• Some patient outcomes were variable. However, we saw that the practice had plans in place to further address these shortfalls. Patient comment cards received were all positive about the service.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients were able to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The facilities and premises were appropriate for the services delivered. The practice had made reasonable adjustments when patients found it hard to access services.
• There was a clear leadership structure and staff felt supported by management.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvements are:

• Consider auditing the system to manage test results to assure yourself that it is functioning effectively.
• Address the outstanding actions of the Infection Prevention and Control audit.
• Continue to monitor patient outcomes in relation to the cervical screening programme and the child immunisation programme.
• Continue to monitor results in relation to the GP national survey.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Connaught Square Practice on 15 June 2017. Overall the practice is rated as requires improvement.

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

• Although risks to patients were assessed, the systems to address these risks were not implemented well enough to ensure patients were kept safe. For example, we found the management of patient safety alerts and some aspects of safeguarding, infection control and medicine management required improvement.
• There was a system in place for reporting and recording significant events; lessons were shared to make sure action was taken to improve safety in the practice. When things went wrong patients were informed as soon as practicable, received reasonable support, truthful information and a written apology.
• Staff were aware of current evidence based guidance. However, healthcare assistants did not have access to clinical protocols to support their role.
• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Patients we spoke with on the day told us they were treated with compassion, dignity and respect and involved in decisions about their care and treatment. However, results of the national GP survey were mixed with patients rating the practice lower than others for some aspects of care.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they could get an appointment with a named GP when they needed it and there was continuity of care, with urgent appointments available the same day.
• Although the practice was equipped to treat patients and meet patient needs the layout of the building had restrictions for patients with accessibility needs and ambulatory difficulties.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

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

The areas where the provider should make improvement are:

• Continue to monitor performance of the Quality and Outcome Framework (QOF) indicators specifically in relation to the cervical screening programme and patient outcomes in relation to the childhood immunisation programme.
• Consider how those with accessibility needs and ambulatory difficulties can use the patient toilet.
• Continue to monitor patient experience and satisfaction with the service provided.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice