Archived: The Meadows Surgery

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