A GP surgery in Cambridgeshire has been taken out of special measures but has still been rated as ‘requires improvement’ over inconsistencies with medicine.

Waterbeach Surgery was placed in special measures after it had been rated as ‘inadequate in 2020.

When inspected in June 2020 it was rated as ‘requires improvement’ overall, the rating it has been given again.

The Care Quality Commission (CQC) conducted the unannounced inspection of the surgery in December last year, with the report on its findings being published in January.

In the ratings breakdown, the surgery was rated as ‘requires improvement’ in the areas of service safety, effectiveness, responsiveness to people’s needs, and how well-led the service is.

It was however rated ‘good’ in how effective its services are and in how caring its services are.

The report said the practice provided care in a way that generally kept patients safe and protected them from avoidable harm.

It said that patients received “effective care and treatment” that met their needs, and that staff dealt with patients with kindness and respect.

The inspection report said the surgery was being taken out of special measures in recognition of the improvements that had been made to the quality of care.

However, the inspectors did find that there were inconsistencies in the reviewing and coding of medicine reviews.

Inspectors also found that 1,008 medicines reviews had not been fully documented or not undertaken in the past 12 months.

The report said: “We found some gaps in the monitoring and clinical oversight of all clinical staff performance and medical record keeping.

“We found examples of poor documentation with medical records. We found a lack of detail which did not endure other health professionals or patients reading the notes would understand or have all the information they may require to assess and treat the patient.

“We found examples of poor coding in respect of patients with chronic kidney disease.

“We found an estimated calculation had been recorded and not an actual calculation. This was because the record did not contain an up to date weight of the patient.”

The report said the surgery must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Laura Lucas, the director of operations at MKGP Plus, which runs Waterbeach Surgery, said: “We are pleased and welcome [the report], we have a good relationship with the CQC and are working towards the improvements.

“There have been quite a few improvements since the special measures, and the team there are working very hard."