We carried out an announced comprehensive inspection at Nuffield House Doctors Surgery on 4 November 2019. This inspection was to follow up on breaches of regulations identified at a previous inspection on 29 April 2019 and to provide new ratings for the practice.
There have been four previous inspections of this practice, three of which were comprehensive inspections where ratings were awarded and one, a focused inspection. The focused inspection was carried out to ensure compliance with a warning notice that was served following the 2017 inspection. The focused inspection was not rated.
We initially carried out a comprehensive inspection on 27 October 2016. At this time, the practice was rated as required improvement overall, with safe, effective and well-led rated as requires improvement. A follow-up comprehensive inspection was undertaken on 8 August 2017 and 5 September 2017. At this inspection the practice was rated as inadequate overall and placed into special measures for a period of six months. The practice was issued with a warning notice.
On 20 March 2018, we carried out a focused inspection to check that the practice had made the necessary improvements required, as highlighted in the warning notice. We found that they had complied with the warning notice.
We then carried out an announced comprehensive inspection on 21 May 2018. This was to check that the practice had made improvements as identified in our previous inspection and to re-rate all key questions and population groups. At this inspection, the practice was rated as requires improvement, with effective, caring, responsive and well-led rated as requires improvement. We carried out a further comprehensive inspection on 29 April 2019. At this inspection, the practice was rate as requires improvement overall with well-led rated as inadequate.
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 requires improvement for providing safe services because:
- There were not effective processes to learn from significant events and so unsafe practices reoccurred.
- Sufficient action had not been taken to improve antibiotic prescribing. Performance for prescribing indicators had been below average or tending towards below average for a number of years.
We rated the practice as requires improvement for providing effective services because:
- The practice is rated as requires improvement for providing effective treatment for people with long-term conditions as patients with diabetes were not regularly having their blood pressure checked. This area of underperformance had been identified at four previous inspections.
- The practice is rated as requires improvement for working age patients. This is because performance was below average for cervical screening and the number of cancer cases treated which resulted from a two week wait referral.
We rated the practice as inadequate for providing caring services because:
- Patient feedback was below average in respect of the care and treatment provided by the clinical and non-clinical staff. In some indicators, performance had deteriorated.
We rated the practice as inadequate for providing responsive services because:
- Patients continued to raise concerns about accessing appointments and getting through on the phone. In some indicators, performance had deteriorated.
We rated the practice as inadequate for providing well-led services because:
- There had been insufficient improvement in areas previously and persistently identified by inspectors.
(Please see the specific details on action required at the end of this report).
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.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care