29/09/2022
During a routine inspection
We carried out an announced comprehensive inspection at Parkside Medical Centre on 29 September 2022. Overall, the practice is rated as requires improvement.
The ratings for each key question are:
- Safe - requires improvement
- Effective - requires improvement
- Caring – requires improvement
- Responsive – good
- Well-led - requires improvement
Following our previous inspection on 3 September 2021, the practice was rated good overall and for the provision of effective and well-led services. The practice was rated requires improvement for the safe key question. The ratings of good for the caring and responsive key questions had been carried over from the previous inspection.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Parkside Medical Centre on our website at www.cqc.org.uk.
Why we carried out this inspection
We inspected Parkside Medical Centre as part of our regulatory functions under the Health and Social Care Act 2008.
We served a requirement notice following our previous inspection as we found there were breaches in regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We carried out this inspection to follow up on the concerns identified in the safe key question, breaches of regulations and the areas identified where the provider should make improvements.
How we carried out the inspection
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 facilities
- completing clinical searches and reviewing patient records on the practice’s patient records system to identify issues and clarify actions taken by the provider
- requesting evidence from the provider
- a site visit to Parkside Medical Centre
- requesting and reviewing feedback from staff and patients who work at or use the service.
Our findings
We based our judgement of the quality of care at Parkside Medical Centre 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 found that:
Systems and processes to manage risks and keep patients safe and protected from avoidable harm were not always effective. For example:
- Not all staff were up-to-date with the practice’s training requirements, such as in sepsis awareness and safeguarding.
- Not all staff had a clear understanding of the procedure if there is a fire.
- The practice had not always responded to safety alerts to protect all patients from harm.
- Some emergency equipment had gone past the expiry date.
There were repeat breaches of the regulations from the last inspection. For example:
- There continued to be gaps in the required monitoring for patients prescribed high-risk medicines and reviews of patients with long-term conditions, such as diabetes.
- Further improvements were needed in the monitoring of staff immunisations.
Patients did not always receive effective care and treatment that met their needs and in a way that kept them safe and protected from avoidable harm. For example:
- Not all staff had had an appraisal in line with the practice’s policy.
- Records relating to do not attempt cardiopulmonary resuscitation (DNACPR) decisions did not always contain adequate information.
- Cervical screening uptake was below the national target.
- Shared care documentation required strengthening.
However, the practice had met the minimum targets and exceeded some national targets for giving childhood immunisations.
Feedback from patients was negative about the way staff treated people and involved them in decisions about their care. Results from the National GP Patient Survey were below the local and national averages and there was no clear plan to address these. For example, the number of patients who were satisfied with the appointment they were offered.
Although the practice supported patients to live healthier lives, systems for identifying and supporting carers required strengthening.
Patients could access care and treatment in a timely way.
Complaints were listened and responded to and used to improve the quality of care.
Governance and performance monitoring systems required strengthening. For example:
• The practice had limited engagement with patients and the public to find out their views.
• The practice did not always act on feedback available to make improvements.
• The practice’s plans about how they would manage backlogs of activity lacked detail.
There was compassionate leadership and a supportive culture in the practice.
We found 1 breach of regulations. The provider must:
- Establish effective systems and processes and operate them effectively to ensure good governance and compliance with the requirements of the fundamental standards of care as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
More detail is contained in the requirement notice section at the end of this report.
We also found the following areas for improvement where the provider should:
- Continue to take action to improve attendance for cervical screening.
- Develop systems to identify and support carers, including ‘young carers’ (those under the age of 18).
- Improve staff awareness of the practice’s vision and their role in the delivery, development and monitoring of it.
- Consider including information in the business continuity plan about when it would be necessary and how to inform other agencies of a disruption.
- Continue to take steps to try to encourage other services to attend multi-disciplinary team meetings.
- Continue to make arrangements to keep all staff up-to-date with the practice’s training requirements, including sepsis awareness and safeguarding.
- Develop effective systems to identify when emergency medicines and equipment need replacing.
- Take steps to improve patients’ satisfaction with their experiences of using the practice.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA
Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services