10 November 2015
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Wyken Medical Centre on 10 November 2015. Overall the practice is rated as inadequate.
We first inspected Wyken Medical Centre on 24 February 2015 with a GP specialist advisor. We found that the practice was in breach of Regulations 12(2)(i), 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We judged the practice to be inadequate in respect of providing services which were safe, effective, responsive and well led. We judged that it was good in providing a caring service. The overall rating for the service was inadequate and we placed it in special measures. This was for a period of six months during which time the provider was expected to improve the practice to meet the required regulations and fundamental standards. Special measures are designed to ensure a timely and co-ordinated response to practices found to be providing inadequate care that gives them support from NHS England and the Clinical Commissioning Group (CCG). Practices can choose to get further peer advice and support from the Royal College of General Practitioners. Being placed into special measures represents a decision made by CQC that a practice has to improve within six months to avoid having its registration cancelled.
Our key findings across all the areas we inspected on 10 November 2015 were as follows:
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Since the previous inspection in February 2015 the practice had made improvements in respect of a number of safety related areas including staff recruitment, fire safety and learning from significant events.
- Medicines, including those for medical emergencies, were not regularly checked, some were out of date and others were not available if needed. Medicines were not all stored appropriately and some medicines prescribed for individuals were being used for other patients.
- The GP was not familiar with the practice’s arrangements for managing safety alerts or for managing safety at the practice including arrangements for medical emergencies and major incidents.
- Infection control was not proactively monitored although improvements had been made during 2015.
- The GP and practice nurse did not have clinical meetings to share and review clinical guidance and reflect on how they needed to take this into account in patient care.
- There was no established system of clinical audits to ensure that care and treatment was provided appropriately and outcomes for patients monitored and improved.
- Whilst some national data showed the practice performed well in some areas of care and treatment this was mixed and we found examples of patients with long term conditions whose care had not been reviewed for three years.
- The GP did not understand their responsibilities under the Mental Capacity Act 2005. This is the legal framework they should use in respect of patients who may lack capacity to make particular decisions for themselves.
- Patients were very positive about the service they received at the practice. They said they were treated with compassion and dignity and spoke highly of the care and treatment they received.
- The practice had increased its opening hours and now provided afternoon appointments three days a week. This had been welcomed by patients and most were now satisfied with the practice’s opening hours.
- The GP had limited awareness of their responsibilities across a range of clinical and non-clinical areas and was over reliant on the practice manager to support the overall management of the service.
- There was a lack of clarity about lead roles and responsibilities at the practice relating specifically to safeguarding, infection control and dealing with patient referrals.
The areas where the provider must make improvements are:
- Introduce robust processes the safe management of medicines.
- Review availability of medicines and equipment to manage medical emergencies and carry out a risk assessment in respect of medicines they decide not to stock.
- Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.
- Ensure that all clinicians understand their responsibilities in respect of the Mental Capacity Act and other legislation and guidelines relating to consent.
- Carry out clinical audits including re-audits to ensure improvements have been achieved.
- Improve formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.
- Clarify the leadership structure and staff roles and responsibilities and ensure there is leadership capacity to deliver all improvements
The areas where the provider should make improvement are:
- Review the practice’s infection control procedures and protocols giving due regard to guidelines issued by the Department of Health - The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’
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Review their recruitment policy to fully reflect the requirements of Regulation 19(3) and Schedule 3 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014.
At the inspection on 10 November 2015 we found that insufficient improvements have been made such that there remains a rating of inadequate overall for this practice. The key areas of safe, effective and well led are rated inadequate and the responsive and caring are rated requires improvement. The ratings for all population groups remain inadequate. We are therefore taking action in line with our enforcement procedures.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice