We carried out an announced follow-up comprehensive inspection at Narborough Road Surgery on 16 September 2019 to follow-up on breaches of regulations identified at a previous inspection on 4 March 2019.
At the previous inspection the practice was rated as requires improvement overall and in the Safe and Well-led key questions. This was because the practice was unable to demonstrate that arrangements for identifying, recording and managing risks, issues and implementing mitigating actions were not operated effectively, in particular in relation to the management of emergency medicines, prescription security, staff training, cold chain security and legionella.
At this inspection we found that the practice had addressed the majority of the concerns that had been identified from the previous inspection, however some had re-occurred and we identified additional concerns.
We based our judgement of the quality of care at this service on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
We have rated this practice as inadequate overall.
We rated the practice as inadequate for providing safe services because:
- Systems and processes in place to ensure that patients on medicines or with long term conditions that require regular monitoring were consistently ineffective. Following the inspection, the practice told us that they were establishing a programme to review all affected patients.
- The practice could not demonstrate that there was a system to ensure clinical supervision of staff, as a result some clinical staff were performing roles outside of their competencies. Following the inspection, the practice told us that they had put checks in place to ensure that all staff were working within their competencies.
We rated the practice as Inadequate for providing effective services because:
- The practice was unable to demonstrate that registers of patients with long term conditions or of vulnerable patients were accurate or updated and therefore data provided for the practice in these areas was unreliable. Following the inspection, the practice told us that they had sought assistance from the local authority to review the registers and address any concerns identified.
- The practice childhood immunisation uptake rates were below target and the practice was unable to provide any updated validated data to demonstrate improvements.
These areas affected all population groups, so we rated all population groups as Requires Improvement. Except for the “People with long-term conditions”, “people whose circumstances make them vulnerable” and “people who are experiencing poor mental health” population groups, that were rated as inadequate.
We rated the practice as inadequate for providing Well-led services because:
- While the practice had made some improvements since our inspection on 4 March 2019, it had not appropriately addressed the Requirement Notice in relation to the patient risk registers. At this inspection we also identified additional concerns that put patients at risk.
- Systems in place to ensure that patients were safeguarded from improper treatment or abuse were not effective. We found that safeguarding registers were not up to date, that concerns had not always been raised with the appropriate authorities in a timely manner and the practice was unable to demonstrate that meetings with the health visitor to discuss concerns were documented. Following the inspection, the practice told us that they had started work to update the safeguarding register and ensure that it was accurate. They were, however, unable to assure us that appropriate action had been taken in relation to the raising of safeguarding concerns or that any communication with health visitors were documented.
- Systems to ensure patient safety were not always effective particularly in the delivery of clinical care and treatment, the practice was unable to demonstrate that they had fully considered all risks or had done all that was reasonably practicable to ensure patient safety. The practice did not always act on appropriate and accurate information.
- Systems to ensure that confidential information relating to patients was kept secure were not fully effective.
- The overall governance arrangements were ineffective. Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
- We saw evidence that there were limited systems and processes for learning, continuous improvement and innovation.
We rated the practice as Requires Improvement for providing caring services because:
- The practice was unable to demonstrate that patient records were kept securely to ensure the privacy and dignity of patients.
- Patient feedback suggested that staff dealt with patients with kindness and respect and involved them in decisions about their care.
We rated the practice as good for providing responsive services because:
- The practice organised and delivered services to meet most patients’ needs. Patients could access care and treatment in a timely way.
The areas where the provider must make improvements are:
- Ensure that care and treatment is provided in a safe way.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
(Please see the specific details on action required at the end of this report).
The areas where the provider should make improvements are:
- Review systems to ensure that patient satisfaction concerning support for low mental health and overall satisfaction improve.
- Review arrangements for confidentiality in the waiting area.
- Review systems to allow homeless patients to easily register at the practice.
- Continue to take actions to increase numbers of carers identified.
- Consider levels of exception reporting to ensure that all are appropriate.
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.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care