Archived: Two Steeples Medical Centre

Letter from the Chief Inspector of General Practice

We inspected on 22 April 2015 and visited the practice in Wigston. We inspected this service as part of our new comprehensive inspection programme. This provider had been inspected before.

We carried out an announced comprehensive inspection at Long Street Surgery on 22 April 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe, effective, caring, responsive services and being well led. It was also inadequate for providing services for the older people, families, children and young people, working age people, people whose circumstances may make them vulnerable and people experiencing poor mental health.

Our key findings across all the areas we inspected were as follows:

• Patients were at risk of harm because systems and processes were not in place to keep them safe. The practice could not provide the inspection team with any evidence that the nurses employed or the health care assistant had indemnity in place to cover their roles.

• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

• Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments and that it was very difficult to get through the practice when phoning to make an appointment.

• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements. There was no practice manager in place and all governance was being carried out by the GP Registered Manager alone.

The areas where the provider must make improvements are:

• Ensure contracts of employment be brought up to date with correct employment role shown. Show evidence that recruitment arrangements include all necessary employment checks for all staff.

• Ensure the health care assistant complete refresher courses for mandatory training.

• Ensure that formal multi-disciplinary meetings take place at regular intervals.

• Ensure blank prescription forms are stored securely and records of issue recorded correctly. The pads must also show the current address of the practice.

• Ensure staff receive full training on the cold chain and the recording of fridge temperatures. Vaccine effectiveness can not be guaranteed unless the vaccine has been stored correctly and therefore a safety issue.
• Take action to address identified concerns with infection prevention and control practice as highlighted in recent audit.
• Ensure all policies and procedures within the practice are up to date.

• Ensure all examination tables are in good order without rips or tears and that phlebotomy needles, sutures, scalpels and scissors are in date and that all of the treatment room curtains had be changed in line with their expiry dates.

• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.

• Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.

• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again within six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice