Background to this inspection
Updated
22 March 2019
Phoenix Medical Group is registered with the Care Quality Commission to provide primary care services. The practice provides services to approximately 7,500 patients from three locations. We visited the Wheatley Hill location as part of this inspection;
- Thornley Practice, Dunelm Road, Thornley, County Durham, DH6 3HW
- The Surgery, Ashmore Terrace, Wheatley Hill, County Durham, DH6 3NP
- The Surgery, 2 The Green, Woodland Crescent, Kelloe, County Durham, DH6 4NU
Thornley Practice is located in purpose-built premises. The practice has its own car park, dedicated disabled parking bays and step free access.
The surgeries at Wheatley Hill and Kelloe are purpose built. They have car parking with disabled bays and level access.
The practice has three GP partners (two male and one female) and one male salaried GP, all are full time. There is one full time advanced nurse practitioner, three practice nurses (WTE 2.4), a phlebotomist (WTE 0.8) and a healthcare assistant (WTE 0.6). There is a practice manager and assistant practice manager, both of whom work full time. There are 13 administration and reception staff (WTE 12.1).
The opening times at the Thornley Practice and The Surgery at Wheatley Hill are 8am until 6pm Monday to Friday. Consulting times at both surgeries are 9am until 11:30am and 2:40pm to 5:30pm.
The Surgery at Kelloe is open Monday to Wednesday 8am until 12:30pm and Thursday and Friday 8am until 12 noon. Consulting times are 9am until 11:30am.
Late evening GP appointments are available on a Monday alternating between Wheatley Hill and Thornley Surgeries. There are early morning and late evening nurse appointments.
The practice is part of a local federation of GP practices which provides extended opening hours for patients; appointments are available late evening, weekend and bank holidays. Patients can contact the practice reception team to arrange appointments. When this service is not provided patients requiring urgent medical care can contact the out of hours service provided by NHS 111.
The practice is part of NHS Durham Dales and Sedgefield clinical commissioning group (CCG). The practice provides services based on a Personal Medical Services (PMS) contract agreement for general practice.
Information from Public Health England places the area in which the practice is located in the second most deprived decile. The income deprivation score for the practice is 36 compared to the CCG average of 30 and the national average of 24. In general, people living in more deprived areas tend to have greater need for health services. Average male life expectancy at the practice is 77 years which is lower than the national average of 79. Average female life expectancy at the practice is 79 years which is lower than the national average of 83 years.
Updated
22 March 2019
This practice is rated as Inadequate overall. (Previous rating March 2018 – Inadequate)
We carried out an announced comprehensive inspection at Phoenix Medical Group on 8 March 2018. We identified breaches of three legal requirements. Requirement notices were issued for two breaches and a warning notice for one breach. On 22 May we carried out an unannounced focused inspection to check whether the provider had taken steps to comply with the legal requirements of the warning notice against:
- Regulation 15 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Premises and equipment.
We found that actions had been taken to address all concerns identified in the breach of regulation.
We carried out an announced comprehensive inspection at the practice on 18 October 2018 to confirm that the practice had carried out their plans to meet the legal requirements in relation to the other two breaches in regulations that we identified in our previous inspection in March 2018, which were;
- Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.
- Regulation 18 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Staffing.
We found that actions had been taken to address the concerns for the breach of regulation 18, most of the concerns in relation to regulation 17 had been addressed, however we identified some new concerns relating to regulation 17.
This report covers our findings in relation to those requirements.
The key questions at this inspection are rated as:
Are services safe? – Inadequate
Are services effective? – Inadequate
Are services caring? – Inadequate
Are services responsive? – Requires improvement
Are services well-led? - Inadequate
The reports of the March and May 2018 inspections can be found by selecting the ‘all reports’ link for Phoenix Medical Group on our website at .
At this inspection we found:
- Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses, however we saw these incidents were not fully investigated.
- The practice had systems to keep patients safe and safeguarded from abuse.
- The practice scored lower than the local clinical commissioning group (CCG) average in almost every question in the National GP Patient Survey.
- Staff were consistent and proactive in supporting patients to live healthier lives through a targeted approach to health promotion.
- We saw evidence of staff involving and treating patients with compassion, kindness, dignity and respect. However, patient satisfaction in this area was lower than local and national averages.
- The practice did not comply with the requirements of the duty of candour.
- We were not satisfied with the leadership at the practice and governance arrangements did not operate effectively.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure that care and treatment is provided in a safe way for patients. (See Enforcement Section at the end of this report for further detail).
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
The areas where the provider should make improvements are:
- Review their arrangements for clinical audit at the practice. Clinical audit should be clearly linked to patient outcomes and monitored for effectiveness.
- Review the satisfaction scores on consultations with GPs in the National GP Patient Survey.
This service will remain in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.
Services placed in 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 a further 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
Please refer to the detailed report and the evidence tables for further information.