Letter from the Chief Inspector of General Practice
This practice is rated as inadequate overall.
(Previous inspections, April 2015 – Requires Improvement, November 2016 – Good)
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – requires improvement
Are services caring? – requires improvement
Are services responsive? – requires improvement
Are services well-led? – inadequate
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People –Inadequate
People with long-term conditions –Inadequate
Families, children and young people –Inadequate
Working age people (including those recently retired and students –Inadequate
People whose circumstances may make them vulnerable –Inadequate
People experiencing poor mental health (including people with dementia) - Inadequate
We carried out an announced inspection at Medlock Vale Medical Practice on 14 November 2017 as part of our inspection programme.
At this inspection we found:
- The practice did not have clear systems to mitigate risk in relation to the safe care and treatment of patients. When incidents did happen although some were investigated and discussed with lessons learnt and shared, we found not all incidents were documented and formally reviewed.
- The practice reviewed the effectiveness of the care it provided. However we found the care and treatment was not always delivered according to evidence based guidelines and action was not taken where appropriate in line with patient safety alerts in a timely manner.
- The practice systems for appropriate and safe handling of medicines were inadequate.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients found appointments overall were available; however they reported challenges accessing appointments as it was not easy to access the practice by telephone.
- In general patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns. A new reception manager had been appointed to ensure managers were available and visible to patients should they require assistance.
- Patients said they could make an appointment with a named GP but some said they may have to wait several days for this appointment. Urgent appointments were available the same day.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- There was a new leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
- The provider was aware of and complied with the requirements of the duty of candour.
- The practice did not have clear systems to assess, monitor and improve the quality and safety of care provided. The practice leadership was reactive rather than proactive and did not have a proven safe track record.
- The practice had an established, proactive patient participation group.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure care and treatment is provided in a safe way to patients
- 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:
- Improve the appointments system in particular telephone access for the patient population for both on the day and pre-bookable appointments, and investigate ways to increase appointment availability.
- Improve ways to increase the number of carers that the practice has registered to ensure that they receive appropriate support.
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.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice