Archived: Fernbank Medical Practice

Letter from the Chief Inspector of General Practice

This practice was first inspected on 17 November 2016 under the previous provider and was rated as requires improvement for providing safe, caring, responsive and well-led services, and found to be inadequate for providing effective services. As a result of our findings during the November 2016 inspection, we asked the practice to provide a report that says what actions they were going to take to meet legal requirements. Since our November 2016 inspection, the practice changed their registration from a two GP partnership to a single handed GP provider.

This practice was inspected on 7 November 2017 under the new registration and rated as inadequate overall.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires improvement

Are services responsive? – Requires Improvement

Are services well-led? – Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those recently retired and students) – Inadequate

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

We carried out an announced comprehensive inspection at Fernbank Medical Practice on 7 November 2017 as part of our inspection programme.

At this inspection we found:

Staff operated systems and processes to support the delivery of services to the local community; however, there were areas where processes were not effective enough to keep people safe. Systems for monitoring training needs were not operated effectively; there was limited participation in multidisciplinary working and the practice did not analyse national surveys or establish plans to improve patient satisfaction. The approach to service delivery, improvements and risk management were reactive and only focused on short-term issues. Clarity amongst the management team regarding their responsibilities was limited and the management team was not always working cohesively.

• The practice had systems to manage risk so that safety incidents were less likely to happen; however, staff members did not consistently follow the system. For example, when incidents happened, the practice were unable to demonstrate that they consistently learned from them and improved processes as a result.

• Safety alerts were not acted on to ensure compliance and corrective actions identified in some risk assessments had not been completed.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was mainly delivered according to evidence- based guidelines. However, the practice did not ensure staff received appropriate training in some areas to cover the scope of their work.

• There were systems in place to monitor and ensure the use of medicines prescribed such as antibiotics remained effective and in line with national guidelines.

• Staff demonstrated how they involved and treated patients with compassion, kindness, dignity and respect. However, results from the July 2017 annual national GP survey showed patient satisfaction was below local and national averages in a number of areas. The practice was aware of these results; however, had not analysed the results or established a plan to improve patient satisfaction.

• Patients found the appointment system easy to use; however, some completed Care Quality Commission (CQC) comment cards and national GP survey results showed that patients were not always able to access care when they needed it.

• The practice operated effective systems for identifying carers and staff were actively involved in ensuring carers received support.

• Complaints were well managed, taken seriously and responded to in a timely way.

• Leadership, management and governance arrangements did not always support the delivery of high-quality and effective care. For example, oversight of systems and processes did not provide assurance that identified risks and areas of poor performance were being sufficiently responded to. There were some evidence of shared learning; however, improvements were not always identified and evidence of actions taken were limited.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients

• Ensure persons employed in the provision of the regulated activity receive the appropriate training necessary to enable them to carry out the duties.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Continue to encourage patients to attend national screening programmes and ensure clear access to cervical screening is established.

• Establish processes for sharing information with community teams to ensure care plans and medication reviews are carried out with patients in receipt of interventions for substance and alcohol dependency and recorded on the clinical syatem.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice