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Archived: Daneshouse Medical Centre

Overall: Inadequate read more about inspection ratings

Old Hall Street, Burnley, Lancashire, BB10 1BH (01282) 423288

Provided and run by:
Dr Kazam Ali Khan

Important: The provider of this service changed - see old profile

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Background to this inspection

Updated 28 August 2018

Daneshouse Medical Centre (Old Hall Street, Burnley, BB10 1LZ) is housed in purpose built, single storey premises on the outskirts of Burnley. The practice has a small car park, with designated disabled spaces and a ramp to facilitate access for those patients experiencing mobility difficulties.

Since our initial inspection visit in April 2017, the provider has appropriately updated their registration with the Care Quality Commission and is now registered to provide regulated activities (diagnostic and screening procedures, treatment of disease, disorder and injury and maternity and midwifery services) as a single-handed GP rather than a partnership.

The practice delivers primary medical services to approximately 3220 patients through a personal medical services (PMS) contract with NHS England, and is part of the NHS East Lancashire Clinical Commissioning Group (CCG).

The average life expectancy of the practice population is below the local and national averages (80 years for females, compared to CCG average of 81 and national average of 83. For males; 74 years compared to CCG average of 77 and national average of 79). The practice patient population contains a higher proportion of younger people when compared to local and national averages. For example, 9% are aged between 0 and 4 (CCG and national averages 6%), 24% aged between five and 14 years (CCG average of 13% and national average of 12%) and 38% aged under 18 (CCG average 23% and national average 21%). Conversely, only 5% of the practice’s patient population are aged over 65, compared to the CCG and national averages of 17%, while 2% are aged over 75 (CCG average 7% and national average 8%).

The practice has a lower proportion of patients with a long-standing health condition (45% compared to the CCG average of 56% and national average of 54%).

Information published by Public Health England rates the level of deprivation within the practice population group as one on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

The practice is staffed by the lead GP (male), with two long term locum GPs (one male, one female) adding a further eight GP sessions of each week. The practice employs a practice nurse for three days each week and has recently added additional nursing time by employing a locum nurse to work an additional two days per week. In addition, a health care assistant works at the practice for three days each week. The clinical team are supported by a practice manager who had commenced employment at the practice in November 2017 and a team of three receptionists / administrative staff.

The practice telephone lines are staffed between 8am and 6.30pm each working day. The practice premises are open from 8:30am until 6:30pm Monday to Friday. Appointments with the GP are available between 9:30am and 11:40am each morning and between 3.30pm and 5:50pm each afternoon, apart from Wednesday afternoon when appointments start at 4pm. Extended hours appointments are also available between 6:30pm and 7.15pm each Monday and Tuesday evening.

Outside normal surgery hours, patients are advised to contact the out of hour’s service offered locally by the provider East Lancashire Medical Services.

We initially undertook a comprehensive inspection of Daneshouse Medical Centre on 5 April 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as inadequate, and we issued warning notices for breaches to Regulation 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Receiving and acting on complaints) and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance). The full comprehensive report following the inspection in April 2017 can be found on our website here: http://www.cqc.org.uk/location/1-586401697.

We then undertook a follow up focused inspection of Daneshouse Medical Centre on 22 August 2017. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice had addressed concerns identified in the warning notices issued. We found the practice was compliant with the breach to regulation 16, as it had improved its management of patient complaints. However, it was only partially compliant with the regulation 17 breach as further improvements around governance were required.

We undertook a further announced comprehensive inspection of Daneshouse Medical Centre on 1 December 2017. While we found some improvements had been made, the practice was rated as requires improvement overall, and we issued a further requirement notice for a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance). The full comprehensive report following the inspection in December 2017 can be found on our website here: https://www.cqc.org.uk/location/1-3679487165.

Overall inspection

Inadequate

Updated 28 August 2018

This practice is rated as inadequate overall. (Previous rating December 2017 – Requires Improvement)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Inadequate

Are services responsive? – Inadequate

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Daneshouse Medical Centre on 27 June 2018 to follow up breaches to regulations identified at our previous inspection in December 2017.

At this inspection we found:

  • The provider had failed to respond appropriately to the concerns identified at the previous inspection and we identified a number of areas where the practice had deteriorated since our last visit.
  • The improvements previously made to systems around managing risk, so that safety incidents were less likely to happen had not been consistently maintained. We saw when some incidents had occurred, the practice learned from them and improved its processes, however, other incidents had not been acknowledged or documented by the provider.
  • We found evidence the practice was not consistently delivering care and treatment in line with evidence based guidelines. We saw examples where patients’ medication was not being appropriately monitored through reviews and health checks as necessary.
  • Clinical leaders lacked comprehensive managerial oversight of the challenges the practice was facing, with limited insight demonstrated as to how they would be addressed moving forward.
  • While patient outcomes for hypertension had improved since out previous visit, outcomes for patients with diabetes had either deteriorated or remained below local and national averages.
  • Clinical audit demonstrated limited evidence of quality improvement.
  • Patient feedback regarding the standard of care and treatment received and access to appointments was lower than local and national averages.
  • Staff did not feel supported or valued and we observed strained working relationships. The practice was experiencing difficulties recruiting and retaining staff.

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

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