Grove Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grove Medical Centre on 10 May 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 10 May 2016 inspection can be found by selecting the ‘all reports’ link for Grove Medical Centre on our website at www.cqc.org.uk.

A subsequent focussed inspection was undertaken on 20 January 2017. The overall rating for the practice remained requires improvement but rated inadequate for being well led. A warning notice was served in relation to the good governance of the practice, Regulation 17.

This inspection was undertaken as an announced comprehensive inspection on 23 August 2017. Overall the practice is now rated as inadequate. Specifically, the practice was rated as inadequate in safe and well led, requires improvement in effective and responsive and good in caring

Our key findings were as follows:

• Staff recruitment checks did not always ensure that evidence was held on file for their employment history and not all staff had references obtained for them.
• Medicine alerts were not acted upon and no evidence was seen that patients were identified as being at potential risk. Patients taking high risk medications were not monitored effectively.
• Although the practice carried out investigations when there were unintended or unexpected safety incidents, lessons learned were not communicated effectively and so safety was not improved. For example there were three significant events featuring wrongly scanned patient information.
• There was insufficient attention to safeguarding vulnerable adults. The practice had different policies in place for this issue which had different information contained within each.
• Non clinical staff had not undertaken training in adult safeguarding.
• Exception reporting for cervical screening was high at 19% and no explanation was given for this(Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
• We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• Data from the national GP patient survey published July 2017 showed patients rated the practice higher than others for some aspects of care.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• No complaint information was displayed within the reception or waiting room area on the day of inspection but information was available on the practice website. Responses to complaints did not follow the practice’s complaint policy.
• The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active but patients spoken to on the day of inspection were not aware of the group or how to contact it.
• Governance arrangements for the oversight and management of risk had not been sufficiently improved leaving a risk of potential harm to patients and staff. For example, the gas safety certificate had expired in March 2017 and this had been identified within the fire risk assessment undertaken in May 2017, yet it remained unresolved at the time of the inspection in August 2017.
• Risk assessments that had been completed had outstanding actions remaining. For example, corrective pipe work to comply with the legionella risk report of May 2016 was still unresolved and documented in the legionella risk assessment of August 2017.
• While we saw that the provider had taken some action against the warning notice issued in respect of Regulation 17, insufficient progress had been made to manage processes effectively.
• The practice met the warning notice in respect of the management of tracking prescription forms throughout the practice.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must ensure:

• That recruitment procedures are established and operating effectively to ensure only fit and proper persons are employed. Information relating to Schedule Three must be available for each person employed. .
• Safe care and treatment must be provided in a safe way to patients, including the proper and safe management of medicines.
• That staff employed by the practice must receive appropriate training to enable them to carry out the duties they are employed to perform. In particular adult safeguarding training for non-clinical staff.
• That the practice establishes and operates effectively an accessible system for identifying, receiving, recording, handling and responding to complaints.
• That systems and processes are established and operated effectively to ensure good governance. Including assessing, monitoring and improving the quality of service provided. For example, reviewing the management of significant events. Assessing, monitoring and mitigating risk relating to the health, safety and welfare of patients and staff. For example, reviewing the management of safety assessments, fire risk assessments, Legionella assessments and gas safety.

In addition the provider should:

• Review access to appointments in line with patient feedback.
• Review the management of the cleaning of the practice to ensure that areas of concern are adequately addressed.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grove Medical Centre on 10 May 2016. The overall rating for the practice was requires improvement. The full comprehensive inspection report published on the 3 August 2016 can be found by selecting the ‘all reports’ link for Grove Medical Centre on our website at www.cqc.org.uk. We had found breaches of legal requirements and the provider was rated as requires improvement under the safe, effective and well led domains. The provider was rated good for providing caring and responsive services. The practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring that blank prescriptions forms used within the practice were tracked.

• Ensuring they could demonstrate an adequate method of recording significant events and had a significant event policy in place.

• Ensure all staff that had unsupervised contact with patients, and those used for chaperoning duties, had been checked by the Disclosure and Barring Service or had a risk assessment in place.

• Ensure staff had received all relevant training.

• Ensure that all recruitment checks had been undertaken prior to employing staff.

There were also areas that we found the practice should improve including:

• Actively identifying patients that had caring responsibilities within their patient list.

• Reviewing their complaints procedure to ensure information is available to escalate a complaint should a patient remain dissatisfied.

• Reviewing and updating their business continuity plan.

• Reviewing induction processes to ensure elements are appropriate to different staff groups and document that these are undertaken.

• Reviewing access to appointments in line with patient feedback.

• Ensuring all safety assessments are undertaken and reviewed as appropriate.

This inspection was an announced focused inspection carried out on 20 January 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 10 May 2016.This report covers our findings in relation to those requirements. Although we found that the provider had made some improvements we still found areas where the provider needed to improve.

Overall the practice is still rated as requires improvement.

Our key findings were as follows:

• The provider had ensured all staff that have unsupervised contact, or undertook chaperoning duties, had a Disclosure and Barring Service check in place.

• All appropriate recruitment checks were completed and recorded prior to employment.

• The provider had reviewed their complaints procedure and now provided the appropriate signposting information to patients should they wish to escalate their complaint.

• The provider had updated their business continuity plan but this did not include contact numbers for key staff members.

• The induction process had been reviewed and documentation was seen that the induction process had been followed.

• Areas in relation to access to appointments had improved in the national patient survey feedback.

• The practice had increased the number of known carers from 135 carers to 321 carers.

  However, there were also areas of practice where the provider needs to make improvements.

  Importantly, the provider must:

• Ensure governance arrangements for the management of risks to patients and staff such as for, safety assessments, fire risk assessment, Legionella assessment and staff training are complete and known risks are corrected as required.

• Ensure their significant event analysis procedure is complied with and enables all significant events to be managed in a timely manner..

• Ensure their recording system in place to track prescription forms used within the practice allows for the correct tracking of all prescription forms.

• Ensure all staff receive appropriate training commensurate to their role, for example, fire training, information governance and Mental Capacity Act (2005) (MCA).

• Ensure that safety assessments are undertaken as required and ensure that they formulate an action plan to address the issues that have been documented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice