A SWINDON surgery has not always kept its patients safe, a bruising report by the care watchdog has found.

Merchiston Surgery has been downgraded to Requires Improvement by the Care Quality Commission following its latest inspection.  

Complaints made to the CQC by patients about access risks at the surgery in Stratton St Margaret were partially responsible for the visit; these included problems with the telephone systems and appointment availability.

Inspectors found that patients did not always receive effective care and treatment and that they could not access care in a timely way.

And a backlog on summarising patient records meant there was a risk staff did not always have updated information needed to deliver "safe care and treatment".

Merchiston Surgery says the report's findings were "disappointing" but "anticipated" as there is a national shortage of doctors and clinicians.

The practice, which has 14,000 registered patients, was rated 'good' in 2018 and has since changed providers to Wyvern Health Partnership.

Inspectors identified that Merchiston had potentially missed diagnosing diabetes in five patients.

And the surgery was "unable" to show that they were appropriately monitoring patients prescribed high-risk medicines and the report found there was a "lack of oversight" to ensure safe care and treatment was given to these patients.

For example, of the 452 patients prescribed a type of medicine to thin blood, 147 had not received "the appropriate reviews" and five had never had a creatine clearance level calculation. This meant there was a risk patients did "not receive the appropriate safe care and treatment".

Another 149 patients prescribed a medicine used to treat partial seizures had not had a medicine review within 12 months to assess whether they were still receiving the correct dose.

The report added: "There was evidence that this controlled medicine was also being issued early with a lack of reasoning within the patient medical records, indicating that the prescribing process is not robust enough to protect patients from potential risks of harm.

"The practice had an action plan in place to address the shortage of clinical staff allocated to medicines management at the practice."

Senior clinical staff told inspectors these issues were down to reduced staffing so high risk clinical care had to be prioritised instead.

Provider Wyvern Health say they are actively recruiting more clinical staff.

Staff had not all received mandatory safeguarding training for children and vulnerable adults so the report assesses there was a risk that patients may not be identified as needing protection from abuse.

The CQC received complaints from Merchiston Surgery patients between January and June this year who highlighted problems with the time it took for telephone calls to be answered and who said they were unable to book appointments or speak to clinicians. 

Patients also suggested there was a lack of clarity about the methods of accessing appointments.

Inspectors were told by senior staff that routine appointments could not be booked in advance and that these appointments are only available on the day because of staff shortages.

"There was a risk that patients with long-term conditions or patients with routine queries would be missed and not receive the same safe care and treatment," the report concluded.

But, in more positive news, inspectors praised the surgery's "proactive" approach to learning from complaints.

The CQC reviewed how the practice dealt with a complaint about the telephone system.

"The provider implemented new infrastructure and cabling for a new telephone system, invested in training for the reception staff and redesigned a new website to keep patients informed on updates."

Merchiston's staff were also judged to be "helpful and courteous towards patients" and "compassionate in their approach".

A spokesman from Merchiston Surgery responded to the report:

“Although it is disappointing to be rated ‘Requires Improvement’ in this CQC report,  it was anticipated, and we are already working towards significant improvements. 

"We are proud of the achievements we have made to date especially after the last two years and the continuing impact of the pandemic.

"We are working closely with Bath and North East Somerset, Swindon and Wiltshire Integrated Care Board and our colleagues across the Wyvern Health Partnership to manage the concerns raised by the CQC appropriately. 

"As some patients will be aware, we have been working hard already to improve our position and the care we are providing the community, inviting patients for blood tests and medication reviews in additional clinics.

"Unfortunately, some of the solutions we have planned will take time to implement, particularly those related to staffing levels and access. 

"There is a national shortage of doctors and clinicians making it difficult to recruit additional staff and cover short notice sickness, particularly with the increased prevalence of Covid in the community. 

"As recognised in the CQC report, the practice has strong culture to drive high quality, sustainable care and that we learn and make improvements when things go wrong."