Archived: Kirkby Community Primary Care Centre Also known as Central Nottinghamshire Clinical Services

Updated 19 November 2015

Kirkby Community Primary Care Centre (KCPCC) is situated in the premises of the Ashfield Health Village. The practice is all on a single level and occupies a converted former ward area. There are 10 consulting and treatment rooms. There are approximately 5,700 patients of all ages registered at the practice.

The practice first opened in 2008 as a new facility for patients in the area.

The practice was operated by Central Nottinghamshire Clinical Services (CNCS) under an Alternative Medical Provider Services contract with NHS England. The practice is also contracted to provide a number of enhanced services, which aim to provide patients with greater access to care and treatment on site.

In our previous inspection in May 2015, the practice was rated as inadequate overall, and we told CNCS that services must improve.

On 30 September 2015 we carried out an unannounced inspection at the practice. During this inspection we saw numerous instances of poor and unsafe patient care also governance issues that placed patients at risk of harm. We took urgent and immediate enforcement action and removed KCPCC from CNCSs registration with CQC.

Updated 19 November 2015

Letter from the Chief Inspector of General Practice

We carried out an unannounced focused inspection at Kirkby Community Primary Care Centre on 30 September 2015. The inspection was to follow up warning notices we issued after an inspection on 13 May 2015 from which overall services provided at the practice were rated inadequate and the location was placed into special measures.

We found the provider to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The regulations breached were:

Regulation 12: Safe care and treatment

Regulation 17: Good governance

As this was a follow up inspection we looked at the areas we identified in the warning notice which were about safe care and treatment to see if the improvements had been made. During the inspection we saw other areas of serious concern.

Our key findings were as follows:

• The provider had made improvements to the calibration and safety testing of equipment.
• Care plans for patients who were at risk of unplanned admission to hospital had been implemented.
• A new system of recording incidents, near misses and concerns had been implemented although it was too early to assess the effectiveness.
• We saw patients had not received essential medicines they needed to treat their condition.
• Children had been put at risk of unsafe care due to the provider’s poor and increasingly worsening performance in administering childhood vaccinations.
• A number of patients had received medicines without any monitoring of their health or in line with their treatment plan.
• The poor governance of record management and lack of oversight for safeguarding children could put them at increased risk of harm.
• There were historic and widespread errors with the accuracy of clinically coding health records which had led to missed opportunities for health screening and safe treatment of patients.

In relation to all of the areas of concern identified, the provider (Central Nottinghamshire Clinical Services) and NHS commissioning organisations were informed to ensure any of the risks identified during our inspection were investigated. We also informed the local authority safeguarding team of our findings.

Following our inspection, due to the serious concerns identified we urgently varied the conditions of provider’s registration with the Care Quality Commission (CQC) and stopped the provider providing GP services at Kirkby Community Primary Care Centre on 2 October 2015.

If the provider was still able to provide GP services at Kirkby Community Primary Care Centre we would have told them they must have made the following improvements:

• The process for providing care and treatment to patients must be carried out in a safe way and to nationally recognised standards.
• Review care records and assess the risks to the health and safety of patients who use the practice.
• Ensure that any incidents that affect, or have affected, the safe care and treatment are recorded, investigated and learnt from.
• Where incidents that have caused harm are identified. Those affected must be told in line with duty of candour.
• Ensure the prescribing, and oversight, of medicines is safe and effective.
• Ensure that medicines are stored in line with manufacturer’s instructions.

As part of our action we liaised with NHS England and NHS Mansfield and Ashfield Clinical Commissioning Group. This ensured that patients had continued access to GP services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 July 2015

The provider was rated as inadequate for safe, effective, responsive and well-led services and requires improvement for caring services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

We saw that measures to provide higher levels of support to help patients with long-term conditions had not been implemented. For example, the provider had not implemented comprehensive care plans for patients at higher risk of unplanned admission to hospital as it had been contracted to do. Patients told us that urgent appointments were not always available and that the lack continuity of care concerned them.

A audit into the treatment of patients with a long-term condition revealed 46% of patients with the condition may not have received the best treatment for their condition. There was no evidence to show that learning from the audit had been shared or that a repeat audit had been undertaken to ensure the situation had improved.

The practice performance outcomes in relation to the review of patients with long-term conditions were in line with the national average.

Updated 16 July 2015

The practice is rated as inadequate for the care of families, children and young people. We saw that joint weekly working with the health visitor to discuss children subject to child protection had not been held for over six months. Staff told us that issues were discussed as required. The practice had recently appointed a interim lead GP to take responsibility for safeguarding children.

Data supplied by the clinical commissioning group (CCG) showed that the practice levels of childhood immunisations had reduced significantly during the last year and were significantly below local averages. For example, in April 2014 the practice rate for providing the measles mumps and rubella (MMR) vaccine to children aged two was 93.5%. In June 2014 the rate was 85.4% and December 2014 the rate was 78.6%. This was significantly lower than the CCG average of 95.5%. Appointments were available outside of school hours.

Updated 16 July 2015

The practice is rated as inadequate for the care of older people. We saw evidence that basic care and treatment requirements were not met. For example, the practice had not implemented care plans for patients at high risk of unplanned admission to hospital, many of which were older patients.

Patients over 75 did not have a named GP, as the practice did not have a permanent regular GP. A local GP had been recruited to act as a interim lead GP and was expected to take on the role.

The care of older people was not managed in a holistic way. For example, the practice had no patients on the practice register for patients who had fractured a bone because of osteoporosis (a condition which leads to fragile bones), this condition can affect patients of any age but is more common in older patients. We were concerned about the absence of diagnosed patients as data from the National Osteoporosis Society suggests that half of patients aged 75 years and over will have osteoporosis as measured on a bone density scan.

We spoke with a member of nursing staff from a local care home who told us that GPs from the practice had stopped doing weekly visits due to the shortage of clinical staff at the practice. Services for older people in care were therefore reactive, and there was a limited attempt to engage with this patient group to improve the service.

Updated 16 July 2015

The provider was rated as inadequate for safe, effective, responsive and well-led services and requires improvement for caring services. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Appointments held outside of working hours had sometimes needed to be rescheduled due to a lack of availability of GPs available to cover appointments within these hours.

The practice offered services that helped patients in this group to access services, For example, online services, telephone appointments and health promotion screening.

The practice performance outcomes within conditions and investigations undertaken that were common in this patient group were in line with the national average.

Updated 16 July 2015

The provider is rated as inadequate for the care of patients experiencing poor mental health (including those with dementia).

Provider supplied data showed that outcomes in this group were significantly below the local and national averages. For example:

• The practice rate for annually reviewing patients who experienced poor mental health was 23%. The CCG average was 68% and national average 75%.
• The practice rate for annually reviewing patients with dementia was 15%. The CCG average was 78.8% and national average 77.9%.
• The rates of review within a nationally accepted timescale for patients who had experienced depression were 3%. This amounted to two patients out of a total of 70.

The results had not triggered a satisfactory response from the provider to investigate the reasons why performance levels were low and that the care provided was appropriate.

Updated 16 July 2015

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable.

The practice kept registers of patients who circumstances may be vulnerable, including those with a learning disability. We requested information from the provider to establish that care provided to patients with a learning disability met nationally recognised standards. This information was not provided despite our requests.

On site clinical leadership at the practice had been absent for a number of months. We saw that the absence of on site clinical leadership and lack of knowledge of patients whose circumstances may make them vulnerable could mean that their care needs were not fully met.