We carried out an announced comprehensive inspection at The Queens Road Partnership, also on 21 February 2019. The practice was previously inspected on 15 December 2015, where they were rated as good for providing effective, caring, responsive and well-led services and good overall. The full comprehensive report of the 15 December 2015 inspection can be found by selecting the ‘all reports’ link for The Queens Road Partnership on our website at .

This inspection was an announced comprehensive inspection carried out on 21 February 2019 as part of our inspection programme. This report covers our findings in relation to the actions we told the practice they should take to improve as well.

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 rated the practice as inadequate for providing safe services because:

• The practice did not have clear systems and processes to keep patients safe.
• The practice had not undertaken criminal record checks for some staff who were performing chaperone duties.
• There were no fire safety checks documented since 2014 and it was unclear when the last fire drill was undertaken.
• Equipment had not been calibrated appropriately.
• The practice did not have appropriate medicines for the safe management of medical emergencies.
• The practice did not have adequate infection prevention control systems and processes in place.

We rated the practice as requires improvement for providing effective services because:

• The practice was unable to show that staff had the skills, knowledge and training to carry out their roles. For example, in relation to lead roles for infection prevention control.
• Staff had not received appraisals since 2017.

These areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as requires improvement for providing responsive services because:

• The practice scored lower than local and national scores in the GP patient in relation to getting through to the practice by telephone and making appointments. Whilst the practice had taken some actions to respond and improve, feedback remained negative in these areas.
• There was limited documented evidence to demonstrate that complaints received by the practice were dealt with in a way that met patient needs and the handling of complaints received by the practice was not in line with national guidelines.

These areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as inadequate for providing well-led services because:

• Whilst the practice had a clear vision, there was no evidence to demonstrate that delivery against the strategy was being monitored.
• The overall governance arrangements were ineffective. Lack of oversight and assessment of the service provided a poor governance structure which meant that issues were not routinely identified and services improved as a result.
• Regular review and updating of policies and procedures was not being undertaken.
• The practice did not have clear and effective processes for managing risks, issues and performance. Issues that could threaten the delivery of safe and effective care were not identified and managed.
• Notifications had not been submitted as required.

We rated the practice as good for providing caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs and worked with staff to develop information leaflets to better support patients.

The areas where the provider must make improvements 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 improvements are:

• Continue to monitor and improve patients experience when telephoning the practice.
• Implement actions to improve the uptake for childhood immunisation and for the cervical screening programme.

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.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice