Archived: North Laine Medical Centre

This practice is rated as inadequate overall. (Previous rating August 2018 – Inadequate)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? - Inadequate

We conducted a comprehensive inspection of this practice on 31 July and 16 August 2018. Breaches of legal requirements were found in relation to the processes to safeguard children and vulnerable adults from abuse, the systems for monitoring patient health in relation to the use of medicines, the management and storage of medicines, governance arrangements and staffing. We issued four warning notices requiring the practice to achieve compliance with the regulations set out in those warning notices. A warning notice was issued against regulation 12 (Safe care and treatment), regulation 13 (Safeguarding service users from abuse and improper treatment), regulation 17 (Good governance) and regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This inspection was a focused inspection carried out on 6 November 2018 to confirm whether the practice was compliant with the warning notices issued following the inspection on 31 July and 16 August 2018. The practice was not rated because of this inspection. Therefore, the ratings remain unchanged as this report only covers our findings in relation to the requirements set out in the warning notices.

At this inspection we found that the requirements of the four warning notices had been met.

Our key findings across the areas we inspected for this focused inspection were as follows:

• The practice had made significant improvements since our last inspection. The processes to identify, understand, monitor and address current and future risks including risks to patient safety had been revised and improved. For example, the processes to safeguard children and vulnerable adults from abuse, the systems for monitoring patient health in relation to the use of medicines, and the management and storage of medicines.
• The practice demonstrated effective systems to ensure that significant events, complaints and safety alerts were always thoroughly recorded, analysed and appropriately stored, and that learning was shared effectively with staff.
• Risks to patients were assessed and well managed. The practice maintained appropriate standards of cleanliness and hygiene. A variety of risk assessments had been completed to monitor safety and maintenance of the premises.
• The practice had taken steps to improve the overall culture and communication in the practice. There was a clear leadership structure and staff told us they felt morale had improved at the practice.

The areas where the provider should make improvements are:

• Strengthen the safeguarding processes to ensure information is consistently stored on the practice system.
• Strengthen the training provided to staff for fire safety.
• Implement the plan to destroy unwanted handwritten prescription pads.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

This practice is rated as inadequate overall. (Previous rating July 2015 – good with requires improvement in Safe. July 2016 – Safe rated good at follow up inspection)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? - Inadequate

On 31 July we conducted an unannounced inspection in response to concerns we had received relating to the management of medicines at the practice, including high risk medicines, and whether all patients had appropriate monitoring and review prior to prescribing. Due to these concerns, and evidence found at that inspection, we continued our comprehensive inspection on 14 August 2018, which was announced. The review of the concerns is incorporated into the findings in this report.

At this inspection we found:

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The processes to identify, understand, monitor and address current and future risks including risks to patient safety were not always effective. For example, the processes to safeguard children and vulnerable adults from abuse, the systems for monitoring patient health in relation to the use of medicines, and the management and storage of medicines.
• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, the practice did not demonstrate that significant events, complaints and safety alerts were always thoroughly recorded, analysed and appropriately stored, or that learning was shared effectively with staff.
• Risks to patients, staff and visitors to the practice were not always assessed or well managed. This included; the systems to manage infection prevention and control (IPC) and comprehensive risk assessments being carried out in relation to safety issues.
• We found that practice policies and procedures were not all routinely reviewed or contained up to date information.
• The practice provided several additional services, including a specialist service for patients diagnosed HIV (human immunodeficiency virus) and delivering new models of care for patients with serious mental health issues.
• We saw examples of comprehensive records that demonstrated positive clinical outcomes.
• There was a leadership structure and most staff felt supported. However, this was not always by the management team. All staff spoke positively about working at the practice.

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.
• Ensure patients are protected from abuse and improper treatment.
• 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.

The areas where the provider should make improvements are:

• Review the premises and facilities provided and ensure all reasonable adjustments are made, including that all patients can raise an emergency alarm if they require assistance.
• Strengthen the processes to archive documentation of authorisations (patient group directions) to administer medicines.

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