Archived: Leicester Medical Group

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Thurmaston Health Centre on 14 December 2017. The practice is rated as good for responsive and caring, requires improvement for effective and inadequate for safe and well-led. Overall the practice is rated as inadequate.

All six population groups;

• Older people:
• People with long term conditions:
• Families, children and young people:
• People whose circumstances make them vulnerable:
• Working age people (including those recently retired and students):
• People experiencing poor mental health (including people with dementia):

are also rated as inadequate as these ratings applied to everyone using the practice including all population groups.

Our key findings across all the areas we inspected were as follows:

• When serious incidents happened the practice had not ensured that the staff and GPs involved had learned from the events or that the learning was communicated to staff in an effective manner.
• Patients had not always been reviewed to ensure medicines were prescribed safely.
• Patients in receipt of medicines prescribed through secondary care providers did not have those medicines clearly identified on their records, posing a risk of inappropriate prescribing.
• The provider had not taken steps to ensure that medicines requiring refrigeration were kept safely to ensure their efficacy.
• The process for monitoring the temperature of fridges used to store medicines was inadequate and posed the risk that the medicines may not be effective.
• Some medical equipment and medicines had passed the manufacturers use by date.
• The provider had an infection prevention and control policy and had recently completed an audit, however we found the practice to be untidy and cluttered in some areas.
• Patient safety alerts and guidance from bodies such as the National Institute for Health and Care Excellence was received into the practice and cascaded to relevant staff but we found the process was informal and not well documented.
• There was no evidence that the provider had always undertaken the appropriate checks before staff started working at the practice.
• The provider did have effective processes in place to monitor performance.
• We had concerns that the partner who ran this practice and was also the registered manager was over-stretched and had insufficient time to ensure good governance.
• The providers safeguarding process was not embedded and there was an absence of meetings with other interested parties.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a lack of information to help support carers.
• The provider had taken positive steps to help reduce isolation in older people and to provide continuing support to people following bereavement.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Following our inspection we contacted the clinical commissioning group who carried out their own visits to the practice.

The areas where the provider must make improvements 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.
• Ensure patients are protected from abuse and improper treatment.
• Maintain appropriate standards of hygiene for premises and equipment.
• Ensure all premises and equipment used by the service provider is fit for use.
• Ensure specified information is available regarding each person employed.
• Undertake quality improvement initiatives to help improve patient outcomes.

The areas where the provider should make improvements are:

• Have in place an effective system to provide assurance that staff have access to and are made aware of patient safety alerts and clinical guidance.
• Have in place information for carers on how to access support services.

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