Archived: Guiseley and Yeadon Medical Practice

We carried out an announced focused inspection at Guiseley and Yeadon Medical Practice on 22 August 2019. The overall rating for the practice following that inspection was inadequate. We identified one breach of legal requirements and issued a warning notice against this breach. The inspection report for that inspection can be found by selecting the ‘all reports’ link for Guiseley and Yeadon Medical Practice on our website at .

This inspection was an announced focused inspection, carried out on 13 February 2020 to check whether the provider had taken steps to comply with the legal requirements of the warning notice issued against Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Good Governance.

This inspection on 13 February 2020 did not result in any new ratings.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We found that:

• The practice had improved the process for recording investigation and learning from significant events and incidents.
• Training records had been reviewed and updated.
• The practice had introduced a schedule of meetings to ensure staff were kept up to date and had the opportunity to provide feedback.
• The practice had improved the processes for checking emergency medications and vaccination fridges.

Whilst we found no breaches of regulations, the provider should:

• Continue to undertake searches to identify adults at risk of abuse in order to produce a safeguarding register.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Guiseley and Yeadon Medical Practice had previously been inspected in November 2016 and was rated as good overall but requires improvement for providing safe services. We carried out a follow-up inspection in March 2018; we found improvements had been made and rated safe as good.

We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

This inspection focused on the following key questions:

• Safe
• Effective
• Well Led

Because of the assurance received from our review of information we carried forward the ratings for the following key questions: responsive (good) and caring (good).

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

• There was no formal mechanism in place to discuss safeguarding concerns and there was no evidence of a register of people at risk of abuse.
• The provider was unable to demonstrate that staff had received the appropriate level of safeguarding training, in particular the GPs and safeguarding lead.
• We saw that the provider had process in place for reporting significant events and incidents. However; we saw no evidence of a thorough investigation and identified learning.
• There was no system in place to ensure regular review of policies and procedures. We reviewed the safeguarding policies and found that these made reference to staff members who no longer worked for the practice.

We rated the practice as requires improvement for providing effective services because:

• The practice had no oversight of training for all practice staff and we were unable to review any records to demonstrate what training had been completed.
• There was no formal supervision in place to support the Advanced Nurse Practitioners (ANPs) working at the practice and not all staff had received an annual appraisal.
• There were some high QOF exception rates, cervical screening rates were below national targets and there were no processes in place to recall patients for coil and implant removal and/or reinsertion

We rated the practice as inadequate for providing well-led services because:

• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
• While the practice had a clear vision, that vision was not supported by a credible strategy.
• The practice culture did not effectively support high quality sustainable care.
• The overall governance arrangements were ineffective.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review the process for monitoring stock levels and expiry dates of emergency drugs.
• Review and improve the systems in place to ensure appropriate fire safety checks are carried out at Netherfield Road Surgery.
• Ensure that CQC ratings are displayed at both sites.

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.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Guiseley and Yeadon Medical Practice had previously been inspected in November 2016 and was rated as good overall but requires improvement for providing safe services. We carried out a follow-up inspection in March 2018. We found improvements had been made and rated safe as good.

We carried out an inspection of this service following our annual review of the information available to us, including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

This inspection focused on the following key questions:

• Safe
• Effective
• Well Led

Because of the assurance received from our review of information, we carried forward the ratings for the following key questions:

• Responsive – good
• Caring – good

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

• There was no formal mechanism in place to discuss safeguarding concerns and there was no evidence of a register of people at risk of abuse.
• The provider was unable to demonstrate that staff had received the appropriate level of safeguarding training, in particular the GPs and safeguarding lead.
• We saw that the provider had a process in place for reporting significant events and incidents. However, we saw no evidence of a thorough investigation and identified learning.
• There was no system in place to ensure regular review of policies and procedures. We reviewed the safeguarding policies and found that these made reference to staff members who no longer worked for the practice.

We rated the practice as requires improvement for providing effective services because:

• The practice had no oversight of training for all staff and we were unable to review any records to demonstrate what training had been completed.
• There was no formal supervision in place to support the Advanced Nurse Practitioners (ANPs) working at the practice. Not all staff had received an annual appraisal.
• There were some high exception rates relating to the Quality and Outcomes Framework (QOF). Cervical screening uptake rates were below the national target. There was no clear process in place to recall patients for coil and implant removal and/or reinsertion.

We rated the practice as inadequate for providing well-led services because:

• Leaders could not clearly demonstrate that they had the capacity and skills to deliver high quality, sustainable care.
• While the practice had a clear vision, that vision was not supported by a credible strategy.
• The practice culture did not effectively support high quality sustainable care.
• The overall governance arrangements were ineffective.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Improve the process for monitoring stock levels and expiry dates of emergency drugs.
• Improve the systems in place to ensure appropriate fire safety checks are carried out at Netherfield Road Surgery.
• Display CQC ratings at all practice locations.

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.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care