An embattled Letchworth GP surgery still faces the threat of closure if it doesn’t sufficiently improve soon – that’s the message after inspectors gave it another overall “inadequate” rating.

Professor Steve Field of the Care Quality Commission made the comments after a check-up visit to the Sollershott Surgery, which was last year placed in special measures amid concerns over safety and management.

In the new report’s summary, he wrote: “Insufficient improvements have been made and further areas of concern have been identified so there remains a rating of inadequate for ‘safe’ and ‘well-led’.

“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 six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.”

Prof Field made the same threat in September last year, when the surgery in Sollershott East was found to have “major flaws” in safety and leadership, with effectiveness and responsiveness also requiring improvement – although services were found to be caring and compassionate, meriting a ‘good’ rating in that field.

Long-time partners Dr Richard Nevard and Dr Nes Irvine left in the months after that scathing report, and since January the NHS has commissioned private providers The Practice Group to run the surgery.

The latest inspection, carried out on July 6, found that there have been improvements in effectiveness – now rated ‘good’ – but still found most aspects of the surgery’s provision to be sub-par.

The visitors criticised how the surgery was managed, asserting that the provider’s vision of high-quality patient-centred healthcare was “not always evident”.

Prof Field wrote: “We found there was a lack of visibility and oversight from the provider in relation to clinical leadership within the practice.

“The provider employed one part-time salaried GP and a part-time advanced nurse practitioner. They used two regular part-time locum GPs in addition to ad hoc locum GPs.

“There were no clinical meetings and we found evidence that a system was not in place for monitoring of high-risk medicines.”

Among other things, electronic records showed that some patients had not received appropriate blood monitoring.

Patients told the inspectors that they found it easy to make an appointment but that there was “a lack of continuity of care” due to the surgery’s reliance on locum GPs.

CQC comments cards completed by 43 patients contained exclusively positive feedback in 19 cases, with staff described as attentive, caring and providing a high standard of care. The other 24 cards gave mixed reviews.

East and North Hertfordshire Clinical Commissioning Group chairman Dr Hari Pathmanathan said in response: “The practice staff and the CCG are both disappointed that Sollershott has received this rating.

“The inspection was rightly thorough and detailed and it highlighted a number of areas where the practice could be doing better.

“The practice has experienced a difficult few years and the current doctors and support staff there have worked hard to start afresh and establish governance processes and, importantly, high-quality patient care.

“All of the issues the CQC identified in its previous inspection last year have now been resolved and the CCG, alongside NHS England, will support the practice to help them continue making improvements.”

Di Pegg, head of primary care for NHS England in Hertfordshire, added: “We would like to assure patients of Sollershott Surgery that the safety and the quality of the services we commission jointly with East and North Hertfordshire CCG are of paramount importance.

“We are working with the CCG and the practice to address concerns and will continue to monitor the standard of care received to ensure that patients can access safe, high-quality services.”