We carried out an announced comprehensive inspection at Keats Surgery on 16 December 2020 as part of our inspection programme, to check on concerns noted at previous inspections. The reports of those inspections can be read on the CQC website at: https://www.cqc.org.uk/location/1-498006035/reports
We had inspected the practice on 12 February 2020, when we rated it inadequate overall and in respect of the safe, effective and well led questions; and requires improvement in respect of the caring and responsive questions. We served Requirement Notices for breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. On 16 & 17 August 2020, we carried out a follow up, unrated, remote regulatory assessment, focussing on the breaches of Regulations 12 and 17 and found that the practice had made insufficient improvements. We therefore served Warning Notices for breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We did not revise the practice’s ratings at this stage.
We took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering how we carried out this inspection. We therefore undertook some of the inspection processes remotely and spent less time on site. We conducted medical records searches on 3 and 9 December 2020 and carried out a site visit on 16 December 2020.
We have rated this practice as Requires Improvement overall.
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 rated the practice as Requires Improvement for providing safe services because:
When we inspected in February 2020, we rated the practice as inadequate for providing safe services because arrangements for monitoring high risk medicines placed patients at risk and the practice lacked effective safety alerts systems. These issues continued to be of concern at our unrated August 2020 Remote Regulatory Assessment. We therefore served Warning Notices for breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; and asked the provider to take action.
At this inspection, arrangements for monitoring Warfarin continued to place some patients at elevated risk but monitoring arrangements for patients prescribed Methotrexate, Lithium and Azathioprine high risk medications had significantly improved. Appropriate arrangements were now also in place for acting on safety alerts.
We rated the practice as Requires Improvement for providing effective services:
When we inspected in February 2020, we rated the practice as inadequate for providing effective service. The practice’s performance was significantly below local and national averages on indicators relating to diabetes, hypertension and asthma. Childhood immunisations uptake was also significantly below the World Health Organisation 95% target.
Additional concerns were highlighted at our unrated August 2020 Remote Regulatory Assessment regarding missed diagnoses and a failure to deliver optimal patient care.
At this inspection, the practice’s performance was in line with local and national averages and monitoring arrangements for patients with diabetes and asthma now supported the delivery of optimal care and treatment. However, child immunisation uptake continued to be below local and national averages. We noted the practice had recruited an additional nurse and that unverified practice data indicated this was beginning to have a positive impact.
We rated the practice as Good for providing caring services:
When we inspected in February 2020, we rated the practice as requires improvement for providing caring services because patient satisfaction on involvement in care and treatment was below local and national averages.
At this inspection, although patient satisfaction on involvement in care and treatment was still below local and national averages, the gap had significantly narrowed. Patient satisfaction on the extent to which clinicians listened was now comparable to local and national averages. We also noted satisfaction on the overall patient experience at the practice was above local and national averages; as was satisfaction on the extent to which patients had confidence and trust in their clinician.
We rated the practice as Good for providing Responsive services:
When we inspected in February 2020, we rated the practice as requires improvement for providing responsive services because the practice continued to provide only limited nursing services. At this inspection, we noted that an additional part time practice nurse had been appointed to enhance flexibility, choice and continuity of care. National GP survey patient satisfaction scores were now also above local and national averages regarding phone access and appointment times.
We rated the practice as Requires Improvement for providing well-led services:
When we inspected in February 2020, we rated the practice as inadequate for providing well-led services because of concerns regarding leadership capacity, governance arrangements and systems for managing risks. Governance arrangements continued to be of concern at our unrated August 2020 Remote Regulatory Assessment. The provider was asked to take action.
At this inspection, governance arrangements regarding safety alerts had improved. However, we noted concerns regarding systems for managing infection risks.
The areas where the provider must make improvements are:
- Undertake a further review of arrangements for monitoring patients prescribed Warfarin, including arrangements with third parties.
- Undertake a comprehensive infection prevention and control audit.
The areas where the provider should make improvements are:
- Undertake premises/security risk assessments.
I am taking the practice out of special measures in recognition of the improvements made since our previous inspection. However, further improvement is required in relation to providing safe, effective and well led services; and for the care provided to Families, children and young people and Working age people.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care