14 September 2016
During an inspection looking at part of the service
Letter from the Chief Inspector of General Practice
This was the third inspection that we had carried out at First Health (Peterborough) UK – Dogsthorpe Medical Centre.
On 19 May 2015 we carried out a comprehensive inspection of First Health (Peterborough) UK – Dogsthorpe Medical Centre. The practice was rated as requires improvement for providing safe, effective, caring, responsive and well led services. As a result of the findings on the day of the inspection the practice was issued with requirement notices for regulation 17 (Good governance) and regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
On 18 April 2016 we carried out a second comprehensive inspection. This inspection was responsive to a whistleblower raising concerns about the practice and to check if the practice had made the changes identified in May 2015. The practice was rated inadequate for providing safe, effective, responsive and well led services, and requires improvement for providing caring services.
At our April 2016 inspection we found that the practice had taken some action to address a number of the shortfalls previously identified. However, inadequate action had been taken to assess or act on other risks, such as the monitoring of significant events and improving patient access. Patients were at risk of harm because systems and processes were not in place to keep them safe. The systems and processes in place to ensure good governance were ineffective and did not enable the provider to assess and monitor the quality of the services and identify, assess and mitigate against risks to people using services and others. As a result of the findings on the day of the inspection the practice was issued with requirement notices for regulation 9 (Person-centred care) and regulation 13 (Safeguarding service users from abuse and improper treatment), and a warning notice for regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The practice was placed into special measures for six months.
On the 14 September 2016, we conducted a focused inspection to ensure that the practice had made the required improvements detailed in the warning notice that had been issued on 17 May 2016 following our inspection of 18 April 2016.
Our findings from this inspection are as follows:
- The practice was unable to demonstrate that they had made sufficient improvements to drive all of the changes necessary for the practice to meet the requirements of Regulation 17 (Good governance) to keep patients safe.
- The practice did not maintain appropriate records to demonstrate that significant events had been analysed, investigated and reviewed at a later date. Learning outcomes were not detailed and showed a lack of clinical oversight in ensuring that the significant events did not reoccur.
- Not all staff we spoke with felt confident that robust arrangements were in place to safeguard children and vulnerable adults from abuse.
- The information needed to plan and deliver care and treatment was not always available to relevant staff in a timely and accessible way through the practice’s patient record system. The practice failed to review pathology results and discharge paperwork from secondary care providers in a timely manner, and the management of correspondence was not always delegated to a staff member who was appropriately trained and qualified.
- Patients we spoke to on the day of inspection told us that they were unable to get appointments when they needed them. We were also told that same day appointments were not always available for children.
Following our focused inspection on 14 September 2016 we took urgent action to suspend First Health (Peterborough) UK from providing general medical services at Dogsthorpe Medical Centre.
This report covers our findings in relation to our focused inspection. You can read our findings from our last inspections by selecting the ‘all reports’ link for Dogsthorpe Medical Centre on our website at www.cqc.org.uk
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice