Archived: Daneshouse Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Daneshouse Medical Centre on 5 April 2017. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not appropriately embedded to keep them safe. For example, patients did not have access to appropriately trained chaperones.

• Staff were not clear about reporting incidents, near misses and concerns and there was limited evidence of learning and consistent communication with staff. We found numerous examples of incidents that had not been recognised as significant events.

• Patient outcomes were lower than local and national averages and there was limited evidence of audits or quality improvement.

• Patients we spoke with were positive about their interactions with staff and said they were treated with compassion and dignity. However, results from the national GP patient survey showed patients rated the practice lower than others for many aspects of care.

• The appointment systems were not effective, with long waits to be seen, so patients did not receive timely care.

• The practice did not have a system in place to effectively manage any complaints received.

• The governance arrangements in place were insufficient to ensure quality care was delivered. Staff were not always fully aware of their roles and responsibilities.

• Policy guidance was inconsistent, with duplicate polices and guidance available which did not always reflect current best practice.

The areas where the provider must make improvements are:

• Introduce reliable processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

• Implement an appropriate system for logging and auditing the location of blank hand written prescription pads.

• Introduce systems for effectively identifying, recording and managing risks and implementing mitigating actions.

• Ensure the policies and guidance available to staff to support them in their roles accurately reflect the work undertaken in the practice and are up to date.

• Establish a comprehensive governance framework so as to allow the practice to effectively assess, monitor and improve the quality and safety of the services provided.

• Establish an accessible system for identifying, receiving, recording, handling and monitoring complaints.

The areas where the provider should make improvement are:

• Ensure all documentation relating to pre-employment checks, including interview notes, are maintained appropriately.
• Consider a more systematic approach to the managerial oversight of staff training.
• Consider implementing a planned programme of clinical audit to ensure completion of full audit cycles so that quality improvement is proactively monitored.
• Consider the use of alerts on the patient record system to notify staff if a patient is also a carer.
• Links should be re-established with the PPG to facilitate further collection of patient feedback. Staff feedback should also be proactively sought.
• Consider more frequent engagement with locality multidisciplinary team meetings.
• Review the appointment and telephone systems to ensure that patients are able to access appointments in a timely manner.
• The business continuity plan should contain more comprehensive information, such as emergency contact details for staff to facilitate the cascade of information.

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