Background to this inspection
Updated
3 August 2018
The registered provider of the service is Dr Peter Szwedziuk and Doctor Annmarie Keeley. The address of the registered provider is 23-29 Albion Place, Maidstone, Kent, ME14 5DY
The practice website is
Albion Place Medical Practice provides primary medical services in Maidstone to approximately 12, 104 patients.
The practice population is in the seventh least deprived decile in England. The practice population has a slightly higher number of income deprived children and older people. The practice population of children and older people are slightly above local averages and the practice population of those of working age are slightly below local and national averages. Of patients registered with the practice, 91% are White or White British, 5% are Asian or Asian British, 1% are Black or Black British, 2% are mixed British and 1% are Other.
At the time of inspection the practice team was made up of one female lead GP and one regular female salaried GP. There are three female nurse practitioners, a male and a female paramedic practitioner and one female health care assistant.
The practice has a General Medical Services (GMS) contract with NHS England. (GMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The practice is part of NHS West Kent Clinical Commissioning Group. Out of hours care is accessed by contacting NHS111.
Albion Place Medical Practice is registered for the following regulated activities: Maternity and midwifery services, Surgical procedures, Diagnostic and screening procedures, Treatment of disease, disorder or injury and Family planning.
Updated
3 August 2018
This practice is rated as inadequate overall. (Previous inspection July 2017 – inadequate)
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Requires improvement
Are services caring? – Good
Are services responsive? – Requires Improvement
Are services well-led? – Requires Improvement
We carried out an announced comprehensive inspection at Albion Place Medical Practice on 24 April 2018, to follow up on breaches of regulations identified at our inspection in August 2017. At a previous inspection, July 2017, we rated the practice inadequate for providing safe and well-led services, requires improvement for providing effective and responsive services, and good for caring.
We issued warning notices in respect of these issues and found arrangements had significantly improved when we undertook a follow up inspection of the service on 29 November 2017. The details of these can be found by selecting the ‘all reports’ link for Albion Place Medical Practice on our website at www.cqc.org.uk/
At this inspection we found:
- The systems to manage risk so that safety incidents were less likely to happen were not always effective. When incidents did happen, the practice learned from them and improved their processes.
- The practice was unable to demonstrate that; patients on high risk medicines were being reviewed appropriately, patient group directions (PGDs) had been revised and updated accordingly and the appropriate two week referral form was in use.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
- The practice was unable to demonstrate that; all clinicians had received training in the Mental Capacity Act 2005, staff had the skills and knowledge to deliver effective care and treatment. The learning needs of all staff had not been identified through a system of appraisals and that all staff were up to date with relevant training. They had continued to improve the staff appraisal systems, in order to help ensure that nurse appraisals included more detailed evidence of clinical matters discussed.
- The practice was unable to demonstrate that staff files had further been improved since our focused inspection visit on 29 November 2017, where we noted that 15 out of 30 files had been completed. We reviewed personnel files and found that whilst training records had been updated, no further action had been taken to address the updating of staff files with proof of identity.
- Clinicians had access to appropriate information to deliver safe care and treatment.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients did not always find the appointment system easy to use and reported that they were not always able to access care when they needed it.
- Patient feedback on the care and treatment delivered by all staff was overwhelmingly positive.
- The practice was unable to demonstrate that; their governance arrangements always followed national guidance on infection prevention and control, all appropriate recruitment checks had been undertaken for existing staff, the system for managing patients on high risk medicines was not always effectively managed and implemented and the system and process for managing personnel files had been improved.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
The registered providers of the service as a partnership have applied to voluntary cancel their registration as a registered partnership. An application has been submitted and CQC has accepted the application for Dr Annmarie Keeley to register as an individual. The change in registration will have no impact on the current patient list and services will continue to be provided from Albion Place Medical Practice.
The partnership were still registered at the time of our inspection visit. There were areas where breaches of regulations were identified and the practice must make improvements:
- Ensure care and treatment is provided in a safe way to patients.
- Ensure that staff employed receive such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.
- Ensure effective systems and processes to ensure good governance in accordance with the fundamental standards.
- Ensure recruitment procedures are further embedded and improved to ensure only fit and proper persons are employed.
There were areas where the practice should make improvements:
- Continue with their plan to conduct clinical audits, in order to improve the quality of services provided.
- Continue with their plan to improve telephone access.
- Ensure that staff understood the practice vision, values and strategy and their role in achieving them.
- Continue with their plan to improve how carers are identified and offered support.
This service was placed in special measures in October 2017. Although improvements have been made these are insufficient such that there remains a rating of inadequate for safe. I am placing the service into special measures for a further six months.
Services placed into special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 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 six months, and if there is not enough improvement we will move to close the service.
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