Lathom Road Medical Centre

We carried out an announced inspection at Lathom Road Medical Centre on 24 and 26 May 2022. Overall, the practice is rated as Inadequate.

We previously carried out announced inspections at Lathom Road Medical Centre in 2016 and 2017. In 2016, the practice was rated good overall, requires improvement in the key question for safe and good for the key questions for effective, well-led, responsive and caring and patient population groups.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Lathom Road Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a full comprehensive inspection following information we received regarding medicines management and to review ratings for the key questions:

• Safe
• Effective
• Responsive
• Well-led

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections/reviews differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider.
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A site visit.

Our findings

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.
• 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:

• The provider did not have clear systems and processes to keep patients safe.
• The provider did not have reliable systems and processes to keep patients safeguarded from abuse.
• The provider did not have a safe system in place to manage safeguarding training for staff.
• The provider did not have a safe system in place to monitor and manage recruitment, including disclosure and barring checks (DBS).
• The provider did not have appropriate systems in place to safely manage high-risk medicines and medicines that require additional monitoring.
• The provider did not operate a safe system regarding the cold chain for vaccines and medicines that require refrigeration.
• The provider did not have a safe effective system in place to manage patient safety alerts.
• The provider did not operate a safe system regarding infection prevention and control, this included staff immunisations and certified immunity.
• The provider did not have a safe effective system in place to safely manage emergency medicines.
• The practice did not have reliable systems in place to manage the practice premises safely.
• There was no failsafe process in place to follow-up female patients who have undertaken cervical screening.
• Not all significant events had been recorded.

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

• Clinical care was not delivered consistently in line with national guidance.
• There was limited monitoring of the outcomes of care and treatment.
• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.
• Some performance data was significantly below local and national averages.

We rated the practice as good for providing caring services because:

• There was evidence that staff treated patients with kindness, care and compassion.
• There was evidence the provider had taken action to improve patient experience at the practice in response to feedback from the patient participation group.
• There was evidence to show how the practice carried out patient surveys and patient feedback exercises.

We rated the practice as good for providing responsive services because:

• Waiting times, delays and cancellations were minimal and managed appropriately.
• Patients reported that the appointment system was easy to use.
• Referrals and transfers to other services were undertaken in a timely way. For example, staff proactively followed up with secondary care, for patients whose appointments have been delayed by the pandemic.
• Patient satisfaction response scores in the national GP Patient Survey had improved.

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.
• The practice culture did not effectively support high quality sustainable care.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• We saw limited evidence of systems and processes for learning, continuous improvement and innovation.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

• Develop a system for regular review of practice policies.

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

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 table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care