Background to this inspection
Updated
15 January 2020
Dr Steven Nimmo, known as Barton Surgery is in the town of Plymstock, Plymouth, Devon PL9 9BR. It is located within the Plymouth local authority and is one of 126 practices serving the NHS Devon CCG area. The practice provides a primary medical service to approximately 2,700 patients of a diverse age group. The deprivation decile rating for this area is nine (with one being the most deprived and 10 being the least deprived).
This is a single-handed practice. The GP is supported by a practice manager. Practice nurses and health care assistants were locums. The clinical team are supported by additional reception, secretarial and administration staff.
The practice is open from Monday to Friday, between the hours of 8.30am and 6pm as per local arrangements. Outside of these times patients are directed to contact the out of hour's service and the NHS 111 number.
The practice offers a range of appointment types including face to face same day appointments, telephone consultations and advance appointments (four weeks in advance) as well as online services such as repeat prescriptions. Appointments can be booked up to four weeks in advance and take place between 8.30am and 5pm. Outside of these times the GPs make telephone calls and sees patients that have been triaged.
The practice has a General Medical Services (GMS) contract with NHS England.
This report relates to the regulatory activities being carried out at:
Barton Surgery,
Horn Lane,
Plymstock,
Plymouth
PL9 9BR.
We visited this location during our inspection.
Updated
15 January 2020
This practice is rated as Inadequate overall.
We carried out an unannounced comprehensive inspection on the 24 October 2019 where we identified significant risks to patients. We issued the Registered Provider a Section 31 Notice of Suspension on the 29 October 2019 to suspend the provider’s registration with immediate effect as we found several breaches of regulations relating to safe, effective, responsive and well-led services. Following this inspection, we have rated this practice as inadequate overall and for all population groups.
The full report on these inspections can be found by selecting the ‘all reports’ link for Dr Steven Nimmo on our website at www.cqc.org.uk.
Following this inspection, we were made aware that the provider had handed his contract back and the practice would be closing. Had this not been the case then the practice would have been placed in special measures. Services placed in special measures would be inspected again within six months. If insufficient improvements had been made such that there remained a rating of inadequate for any population group, key question or overall, further action in line with our enforcement procedures would begin.
This inspection on the 15 November 2019 was an unannounced focused inspection. The purpose was to gather evidence on improvements made by the practice against the suspension notice, to present to a first-tier tribunal hearing, following the concerns identified at the previous inspection.
The practice was closed to patients, but we were able to talk to the Practice Manager and two staff members and review documentation. The registered manager was not present.
Concerns from the inspection on 24 October 2019 included: -
- Safety systems, processes and standard operating procedures are not fit for purpose. The management of systems around health and safety, patient emergencies, recruitment, fire safety and infection control were not effective and unsafe.
- The information needed to plan and deliver effective care, treatment and support was not comprehensive and some patient consultation records lacked accurate and robust notes of care and treatment.
- Patients’ treatment and care was put at risk due to inappropriate medicines management.
- Receptionists had not been given guidance on identifying deteriorating or acutely unwell patients. They were not aware of actions to take in respect of such patients. Staff were untrained in basic life support, identifying signs of sepsis, mental capacity and safeguarding at the role-appropriate level.
- There was limited monitoring of the outcomes of care and treatment. Performance data was significantly below local and national averages.
- The practice had not obtained up to date Disclosure and Barring Service (DBS) checks or undertaken risk assessments for staff working in the practice.
- Patients were not encouraged to express their views about their care and support. Complaints and concerns could not be made in accessible ways.
At this focused inspection, we found very few improvements had been made in relation to the concerns we previously identified. The improvements made were in relation to:
- Medicines requiring refrigeration were not stored safely in the two fridges. The practice did not have assurance that the vaccines were stored at the correct temperature for them to remain effective. At this inspection we saw records that demonstrated daily checks were being made.
- At this inspection on the 15 November 2019 we saw evidence to demonstrate that two members of staff had completed on line training for health and safety topics between the 1 November and 11 November 2019 but no other training, for example identifying signs of sepsis, had taken place. One staff member told us they had been asked to complete the training, but they had not had the time.
- Staff files identified gaps in the recruitment system, two of the three files looked at contained no references, no employment histories or record of qualifications.
- Disclosure and Barring Service (DBS) checks had been commenced, we saw application reference numbers alongside undated risk assessments for non-requirement. A further DBS check was dated 8 November 2019.
- We were verbally informed by the practice manager that a new fire risk assessment had been carried out on 1 November 2019 and minor issues, for example more emergency lighting and new seals on fire doors were required.
Following this inspection, we served a further notice under Section 31 of the Health and Social Care Act 2008. This notice formally notified the provider their suspension of registration as a service provider in respect of the regulated activities has been extended from 25 November 2019 until 31 January 2020