Doctors at a practice in St Ives that was rated inadequate by inspectors admitted they were shocked by the findings, but used the report to bring about a rapid improvement in standards.

In a Care Quality Commission (CQC) report issued this week, Dr Renate Marsh and Dr Germaine Tong, GP partners at the Orchard Surgery, reflected on the journey undertaken at the practice after it was rated inadequate in January last year.

Dr Tong said: "I was out of the country when the first report was published and was scared we were going to be closed down," but Dr Marsh recognised the findings in the report, adding: "Some things at the practice were slightly archaic; there was some resistance to change".

After consulting with inspectors from the CQC, the management team at the practice formed a working group made up of doctors, nurses, and administrative staff in order to identify issues and work together to solve them.

As a result, communication between teams at the practice improved and ideas for change were encouraged and implemented. Issues, including inconsistent procedures in reception and ineffective handovers between staff were, addressed and changes quickly made.

"The culture has changed and communication is much better", said practice dispenser Alison Kitchen-Jarvis. "New staff have joined, bringing different ideas. The practice is now open to ideas and decision-making is very transparent. Teamwork is key to improvement. Management is motivated to improve and they want to hear from us."

As a result of the improved structure at the practice, its rating was upgraded to 'good' later in the year, after a follow-up visit from inspectors.

There are still issues to address, however, with Dr Marsh adding: "We're still not where we want to be". Possible improvements include longer opening hours, enabling nurses to handle more appointments and making further improvements to processes such as ordering medicines.

A spokesman for the CQC said: "Many improvements at Orchard Surgery are immediately obvious to patients: there is more information on the website, including online forms; more engagement with the new patient participation group; and notices in the waiting room are clearer and up-to-date.

"There are also new clinics, for example for asthma, and nurses triage patients more often. Behind the scenes, safety and risks are managed appropriately, including upgraded storage for medicines and implementing fire safety measures."