Background to this inspection
Updated
2 August 2019
The Molebridge Practice is situated in Leatherhead, Surrey. The Molebridge Practice provides general medical services to approximately 5,400 registered patients. The practice delivers services to a slightly higher number of patients who are aged 65 years and over, when compared with the national average. Care is provided to patients living in residential and nursing home facilities and a local hospice. Data available to the Care Quality Commission (CQC) shows the number of registered patients suffering income deprivation is lower than the national average.
The practice has had a number of different providers over a short space of time. This has meant different leaders / partners, different working structures, different practice managers and an unstable work force. It is recognised that sustainable care is affected without long term stable leadership, stable clinical and administration teams in place.
The practice is registered to two GP partners who do not work directly at the practice. Instead the practice is supported by a salaried GP and two long term locum GPs. The practice also employs a advanced nurse practitioner, a health care assistant and is supported by a team of reception and administration staff as well as an assistant practice manager and a practice manager.
We informed the practice that their current Registered Manager registration was incorrect. The registration was for a GP who had retired from the practice. The provider also needs to be registered for family planning.
Services are provided from the following premises, and patients can attend either of the two practice premises. For this inspection we only visited the Fetcham Medical Centre.
North Leatherhead Medical Centre, 148 - 152 Kingston Road, Leatherhead, Surrey, KT22 7PZ.
Opening Times
Monday and Tuesday 8am to 1pm
Wednesday 1pm to 6.30pm
Thursday 1pm to 7pm
Friday 7.30am to 1pm
And
Fetcham Medical Centre, 3 Cannonside, Fetcham, Leatherhead, Surrey, KT22 9LE.
Opening Times
Monday, Tuesday and Friday 1pm to 6.30pm
Wednesday 7.30am to 1pm
Thursday 8am to 1pm
During the times when one of the premises is closed, patients are able to access appointments from the other premises and evening appointments from the local hub providing extended access from 6pm to 9pm during weekdays and weekend appointments between 9am to 1pm.
There are arrangements in place for services to be provided when the practice is closed and these are displayed at the practice, in the practice information leaflet and on the patient website.
For further details about the practice please see the practice website: www.themolebridgepractice.nhs.uk
The practice is registered with CQC to provide the following regulated activities:
Maternity and midwifery services
Diagnostic and screening procedures
Treatment of disease, disorder or injury
Surgical Procedures
Updated
2 August 2019
We carried out a short announcement focused inspection at The Molebridge Practice on 26 June 2019 due to concerns raised. Because of the concerns raised we focused the inspection on the safe, effective and well led domains
The practice has been inspected previously with it last being rated as good. All previous reports can be found by selecting the ‘all reports’ link for The Molebridge Practice on our website at www.cqc.org.uk.
Concerns raised to us included the safe, effective and well led domains and although some of these concerns were not founded we did find areas of concern and these domains have been rated as requires improvement. During the inspection looked at the following key questions
- Is it Safe
- Is it Effective
- Is it Well led
Our judgement of the quality of care at this service is based 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.
The practice is rated as requires improvement overall and for all the population groups.
The key question is now rated as:
Are services safe? – requires improvement
Are services effective? – requires improvement
Are services well led? – requires improvement
We rated the practice as requires improvement for providing safe services because:
- Infection control and cleaning standards needed to be improved, including the quality control checks for medicines and equipment used
- Medicine management needed to be more robust including, storage, checking of expiry dates and recording of fridge temperatures where vaccines were stored and the tracking of blank prescriptions
- We were unable to see all of the required information for staff recruitment files as these were held by a previous provider and so we could not be assured that the required information was present
- Health and safety risk assessments were not completed
- Action taken from safety alerts were not recorded
We rated the practice as requires improvement for providing effective services because:
- Staff training was not up to date
- Nursing staff did not receive clinical supervision
- There was no evidence of quality improvement reviews. For example, clinical audits
- There was no pro-active monitoring of QOF with detailed action plans to address low QOF figures or high exception reporting.
We rated the practice as requires improvement for providing well led services because:
- The provider could not demonstrate they had the capacity and skills to deliver high quality sustainable care
- We found little evidence of systems and processes for learning and continuous improvement
- The practice did not have systems in place for identifying, managing and mitigating risks
- There was no detailed strategy or vision for how the practice was going to address staffing concerns and improve its resilience
The areas where the provider must make improvements are:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
- Ensure care and treatment is provided in a safe way to patients
- 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 recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed and specified information is available regarding each person employed
(Please see the specific details on action required at the end of this report).
The areas where the provider should make improvements are:
- Review how records of staff immunisation status are recorded
- Review clinician’s registration to ensure this is up to date
- Continue to review and improve ways to increase the number of carers
- Continue to review and improve ways to increase uptake for cervical screening
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