Archived: The Meadows Surgery

Updated 28 January 2016

The Meadows Surgery provides a range of primary medical services from its premises at Meadow Lane, Thrapston, Kettering, Northamptonshire, NN14 4GD.

The practice serves a population of approximately 5,439. The area served is less deprived compared to England as a whole. The practice population is predominantly white British. The practice serves an above average population of those aged from 5 to 19 and 40 to 69. There is a considerably lower than average population of those aged between 20 and 34 and a lower than average population of those aged 70 and above.

The clinical team includes one male and one female GP partner, one long term female locum GP and two female practice nurses. The team is supported by a counsellor, a practice manager, an assistant manager and seven other administration, reception and secretarial staff. The GP partners work 10 sessions each and the locum GP works three sessions weekly. The practice is on a GMS contract.

The practice is staffed with phones lines open from 8.00am to 6.30pm Monday to Friday with the doors open from 8.30am to 6.00pm. Appointments are from 9.00am to midday and 4.00pm to 6.00pm daily. In addition to this, there is early opening every Tuesday from 7.00am and late opening until 7.00pm every Monday. An out of hours service for when the practice is closed is provided by Nenedoc Limited.

Updated 28 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced inspection of The Meadows Surgery on 25 November 2015. This was a comprehensive inspection under Section 60 of the Health and Social Care Act (2008) as part of our regulatory functions. The practice achieved an overall rating of inadequate. Specifically, we found the practice to be inadequate for providing safe, effective and well-led services. We found it to be good for providing caring services and requires improvement for providing responsive services. Consequently, it is rated inadequate for providing services for older people; people with long-term conditions; families, children and young people; working age people; people whose circumstances may make them vulnerable and people experiencing poor mental health.

Our key findings were as follows:

• The processes for recording action and learning points from reported incidents and events and reviewing the effectiveness of any action taken were insufficient.

• Staff were not receiving safety alerts relevant to the area of care they were responsible for.

• Adequate procedures for completing the required background checks on staff were lacking.

• Some systems designed to assess the risk of and to prevent, detect and control the spread of infection were lacking or not fully implemented.

• Systems to ensure the appropriate management of medicines were lacking or not fully implemented.

• Systems designed to assess, monitor, mitigate risks to and improve the quality and safety of services for patients were insufficient. For example, there was no programme of repeated (full cycle) clinical audit.

• Available data showed the practice was performing below local and national standards for a range of chronic conditions management.

• A system to ensure patients were reviewed at required intervals to ensure their treatment remained effective was lacking. There was a risk patients would not receive the appropriate management, medication and review for their conditions.

• There was no clear leadership structure at the practice. There was no active leadership role for overseeing that any systems in place to monitor the quality of the service were consistently being used and were effective. There were limited formal governance arrangements.

• Some patient feedback was that access to appointments was poor and getting through to the practice by phone was difficult. The wait for some advance release pre-bookable appointments was long.

• We saw patients receiving respectful treatment from staff. Patients felt they were seen by friendly and helpful staff. Patients reported feeling satisfied with the care and treatment they received.

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

Importantly, the provider must:

• Not register any new patients without the prior written agreement of the Care Quality Commission.

• Ensure there is sufficient clinical capacity within the practice to allow for the appropriate clinical leadership and governance arrangements to be embedded and systems that govern activity to be fully implemented.

• Ensure there is sufficient management support for the practice to complete and sustain improvements to enable compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Implement systems to record the completion of and any complications arising from minor surgery at the practice and to monitor and review the histology requests made.

• Ensure key performance indicators are met each month in respect of chronic conditions management and review.

• Ensure that safety alerts are received, distributed appropriately and have their recommendations implemented.

• Ensure the timely and accurate completion of records relating to patients’ health, care and treatment.

• Ensure that the review and clinical oversight of hospital referrals is completed.

• Ensure an appropriate system is in place for the safe use and management of medicines and prescriptions, including medical consumables.

• Ensure that systems designed to assess the risk of and to prevent, detect and control the spread of infection are fully implemented.

• Ensure that all applicable staff receive a criminal records check and that the required information is available in respect of the relevant persons employed.

• Ensure that all staff employed are supported, receiving the appropriate supervision and completing the essential training relevant to their roles.

• Ensure that where responsibility for patients’ care and treatment is shared with others it is organised and completed appropriately.

• Take steps to act on feedback from patients for the purpose of improving the service. This may include reducing the waiting time for routine pre-bookable appointments and improve patients’ access to the practice by telephone.

On the basis of the ratings given to this service at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the service again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 January 2016

The practice is rated as inadequate for the care of people with long-term conditions because the processes and procedures at the practice were not safe, effective, responsive or well-led and this put all patients at risk. Structured annual reviews were not always undertaken to check that patients’ health and care needs were being met. Those reviews completed were not always appropriately recorded and coded. There was no clear clinical leadership structure at the practice which had named members of staff in lead roles for a range of long-term conditions. Available data for this practice showed it was performing below local and national standards for the care of patients with asthma, chronic obstructive pulmonary disease and diabetes among others. However, all newly diagnosed patients with diabetes were managed in line with an agreed pathway. Patients with long-term conditions had access to a named GP and targeted immunisations such as the flu vaccine.

Updated 28 January 2016

The practice is rated as inadequate for the care of families, children and young people because the processes and procedures at the practice were not safe, effective, responsive or well-led and this put all patients at risk. However, there were six week post-natal checks for mothers and their children. Programmes of cervical screening for women over the age of 25 and childhood immunisations were available to respond to the needs of these patients. Available data for this practice showed it was performing slightly below local and national standards for cervical screening. Appointments were scheduled to be available outside of school hours. A range of contraceptive and family planning services were available. The premises was suitable for children and babies.

Updated 28 January 2016

The practice is rated as inadequate for the care of older people because the processes and procedures at the practice were not safe, effective, responsive or well-led and this put all patients at risk. There were no formal or recorded multi-disciplinary team meetings to discuss the needs of complex patients including palliative patients. There was a risk that some older people with end of life care needs would not receive a full and appropriate multi-disciplinary review. However, older patients had access to a named GP, home visits when needed and targeted immunisations such as the flu vaccine.

Updated 28 January 2016

The practice is rated as inadequate for the care of working age people (including those recently retired and students) because the processes and procedures at the practice were not safe, effective, responsive or well-led and this put all patients at risk. There was a low uptake for the health checks available for all patients between 40 and 74 years old.

However, the practice offered online services such as appointment booking and repeat prescriptions. There was additional out of working hours access to meet the needs of working age patients. There were extended opening hours with early opening every Tuesday from 7.00am and late opening until 7.00pm every Monday.

Updated 28 January 2016

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia) because the processes and procedures at the practice were not safe, effective, responsive or well-led and this put all patients at risk. Available data for this practice showed it was performing below local and national standards for such things as dementia care. The practice’s data showed that none of its identified patients experiencing dementia had received a health review in the past 12 months. There were no formal or recorded multi-disciplinary team meetings to discuss the needs of complex patients including those experiencing poor mental health. There was a risk that some of those patients would not receive a full and appropriate multi-disciplinary review. There was no clinical lead for those patients.

However, mental health trust well-being workers were based at the practice twice each week. The practice employed its own counsellor for three sessions a week. Patients could access these to obtain psychological and emotional well-being counselling and advice through referral from the GPs. A drug and alcohol counsellor was available at the practice twice each week.

Updated 28 January 2016

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable because the processes and procedures at the practice were not safe, effective, responsive or well-led and this put all patients at risk. The practice’s data showed that patients with a learning disability received an annual health review. However, those reviews completed were not always appropriately recorded and coded. There were no formal or recorded multi-disciplinary team meetings to discuss the needs of complex patients including those whose circumstances may make them vulnerable. There was a risk that some of those patients would not receive a full and appropriate multi-disciplinary review.

However, the practice maintained a register of patients who were identified as carers and additional information was available for those patients. Staff knew how to recognise signs of abuse in vulnerable people and were aware of their responsibilities in raising safeguarding concerns.