Bryant Street Medical Centre - Surgery C Also known as Bryant Street Medical Centre

We carried out an announced comprehensive inspection at Bryant Street Medical Centre on 14 November 2019 as part of our inspection programme.

We decided to undertake an inspection of this service following our annual review of the information available to us. This inspection looked at the following key questions:

• Safe
• Effective
• Caring
• Responsive
• Well-led

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 and for safe and well-led services. We rated them as requires improvement for effective and caring and good for responsive. We rated the practice as requires improvement for long term conditions, families, children and young people, working age people and people experiencing poor mental health population groups. We rated the practice as good for older people and people whose circumstances may make them vulnerable groups.

We rated the practice as inadequate for providing safe services because:

• There was no system for recording and acting on safety alerts.
• The practice had not undertaken a risk assessment for emergency medicines.
• Medicines and prescription stationary were not stored securely.
• The system for learning and improving when things went wrong was not comprehensive.
• The practice could not demonstrate that recruitment checks and Disclosure and Barring Service (DBS) checks were undertaken when required.
• There was not a system in place to monitor the ongoing registration of clinical staff.
• Staff vaccinations were not monitored in line with Public Health England guidance.

We rated the practice as inadequate for providing well-led services because:

• Leaders could not show that they had the capacity and skills to delivery high quality, sustainable care.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• We saw limited evidence of systems and processes for learning, continuous improvement and innovation.

We rated the practice as requires improvement for providing effective services because:

• There was limited monitoring and improvement to patient outcomes, particularly in relation to diabetes and hypertension.
• Exception reporting was high in relation to long term conditions and mental health.
• The practice could not demonstrate up to date training for all staff including locum staff.
• Childhood immunisation uptake was below target.
• Cervical screening uptake and other cancer screening was below average.

We rated the practice as requires improvement for providing caring services because:

• Survey results showed that patient satisfaction with how they were cared for was below average.
• The practice did not have action plans in place for how they would improve patient satisfaction.

We rated the practice as good for providing responsive services because:

• The practice organised and delivered services to meet 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.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Ensure that fit and proper persons are employed.

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