Wibsey and Queensbury Medical Practice

We carried out an announced focused inspection at Wibsey and Queensbury Medical Practice on 2 July 2019. The overall rating for the practice following that inspection was inadequate. We identified breaches of two legal requirements. A requirement notice was issued for one breach and a warning notice for the other. The inspection report for that inspection can be found by selecting the ‘all reports’ link for Wibsey and Queensbury Medical Practice on our website at .

This inspection was an announced focused inspection, carried out on 22 January 2020 to check whether the provider had taken steps to comply with the legal requirements of the warning notice against Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Good governance.

This inspection on 22 January 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 provider had complied with the warning notice for Regulation 17 of the Health and Social Care Act 2008, Good Governance.

We saw that:

• There was a system in place to ensure that correspondence relating to patient care was acted upon within appropriate timescales.
• The practice had updated the significant event/incident reporting process to ensure, lessons learned and action taken as a result of the event were clearly documented.
• Staff appraisals had been clearly documented and there was a record in place for future appraisals.
• We saw evidence of clinical and practice wide meetings where information had been discussed and shared.
• Policies and procedures were regularly reviewed and updated.
• The practice had implemented a new process to ensure that all staff were offered appropriate immunisations via the local occupational health department. There was a staff immunisation policy to support this.
• There was a locum policy in place which outlined the various checks that should be carried out prior to employment.
• The practice had implemented safeguarding training records for each staff member, this outlined the level of training required and various options to enable to staff member to reach these requirements.

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

• Continue to monitor and review the new process for handling correspondence relating to patient care.
• Continue to monitor and review the new process regarding staff immunisation and fitness to work confirmation.

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

We previously inspected this provider in February 2015 and rated the location as good in all domains.

We carried out an inspection of this service on 2 July 2019 due to the length of time since the last inspection. Following our review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions: effective and well-led.

As a result of concerns identified during our inspection, we expanded the scope to also inspect the key question of safe.

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

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.

The practice was rated as inadequate for providing safe, effective and well-led services.

We found that:

• The practice did not have clear systems and processes to keep patients safe.
• The practice did not have adequate systems of governance.
• The care and treatment provided to patients living with some long-term conditions and those experiencing mental health difficulties was below local and national standards.

We have rated this provider as inadequate for providing safe services because:

• Staff immunisation records were incomplete.
• Patient correspondence was not consistently managed in a timely way.

• A fire risk assessment undertaken in August 2018 had not been fully acted upon. The assessment had been undertaken at the main location. However, no assessment had been undertaken at the branch location.
• Insufficient health and safety risk assessment activity had been undertaken.
• Arrangements for the management of infection prevention and control, including policy and training were absent or insufficient.
• There was inconsistent monitoring of emergency equipment. For example; emergency medicines, the emergency oxygen and defibrillator were not checked between 20/03/19 to 29/05/19. We also saw that vaccine fridges were not consistently checked on a daily basis during the working week, to be assured that temperatures were in range.
• There was inconsistent reporting, review and learning in regard to significant events.
• Non clinical staff told us that they had not received any training in the identification of sepsis.

We have rated this provider as inadequate for providing effective services. The population groups of People with long-term conditions and People experiencing poor mental health (including people with dementia) were both rated as inadequate because:

• The care and treatment provided for patients living with the long-term conditions of asthma, COPD and hypertension was significantly lower than local and national standards, as measured by QOF.
• The care and treatment provided for people experiencing poor mental health (including people with dementia) was significantly lower than local and national standards, as measured by QOF.

The population groups of Older people, Families, children and young people, Working age people (including students) and People whose circumstances make them vulnerable are rated as requires improvement because although we saw examples of good practice, the issues identified under effective also impacted on all population groups.

We have rated this provider as inadequate for providing well led services because:

• Policies were not consistently developed or applied, including those relating to staff training, IPC, recruitment and occupational health.
• Governance structures and leadership were inconsistent in relation to risk assessment activity, clinical meetings and patient safety.
• Not all staff had received an annual appraisal.
• We saw that there was no central oversight of required training (including safeguarding) for clinical staff.
• The provider did not retain documentary evidence to confirm that the registration of clinical staff had been checked and there was no system to regularly monitor professional registration.
• The provider did not have a written policy to verify the identity of locum doctors.

However, we also found that:

• The practice had a caring and compassionate ethos and staff felt supported.
• Some quality improvement activity was undertaken including clinical audit.
• Patient feedback regarding the service was generally positive and described staff as caring and professional.

The areas where the provider must make improvements as they are in breach of regulations are:

• The service provider must ensure care and treatment is provided in a safe way to patients.
• The service provider must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Improve their approach to internal staff communication to be assured that all staff are engaged with the provider’s vision and strategy.
• Improve the care and treatment provided for patients living with the long-term conditions of asthma, COPD and hypertension.
• Improve the care and treatment provided for people experiencing poor mental health (including people with dementia).

I am placing this service into 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 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.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

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