4, 8 and 9 June 2015
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an un-announced comprehensive inspection at Goodwood Court Medical Centre on 4, 8 and 9 June 2015. Overall the practice is rated as inadequate.
Specifically, we found the practice inadequate for providing safe, effective, caring, responsive services and being well led. It was also inadequate for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).
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 13: Safeguarding service users from abuse and improper treatment
Regulation 15: Premises and equipment
Regulation 16: Receiving and acting on complaints
Regulation 17: Good governance
Regulation 18: Staffing
Regulation 19: Fit and proper persons employed
Our key findings across all the areas we inspected were as follows:
- Patients were at serious risk of harm because the practice had not provided sufficient suitably qualified staff to meet their needs.
- Patients were at serious risk of harm because systems and processes were not in place to keep them safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment and actions identified to address concerns with infection control practice had not been taken.
- Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.
- Medicine management practices were unsafe and placed patients at serious risk of harm. This included requests for prescriptions. These had not been processed in a timely manner to ensure patients had access to their medicines.
- Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
- Urgent appointments were usually available on the day they were requested. However patients said that they had to wait a long time for non-urgent appointments and that it was very difficult to get through to the practice when phoning to make an appointment. Patients often experienced long delays when waiting to be seen by the GP.
- The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.
- There were multiple breaches of regulations relating to safe; a safe track record; learning and improvement from safety incidents; reliable safety systems and processes; medicines management; cleanliness and infection control; staffing and recruitment; monitoring safety and responding to risk, and arrangements to deal with emergencies and major incidents.
- There were multiple breaches of regulations relating to effective; management, monitoring and improving outcomes for people; effective staffing; working with colleagues and other services; consent to care and treatment; and health promotion and prevention.
- There were multiple breaches of regulations relating to responsive; responding to and meeting people’s needs; access to the service; listening and learning from concerns and complaints.
- There were multiple breaches of regulations relating to well-led; vision and strategy; governance arrangements; leadership openness and transparency; and seeking and acting on feedback from patients, public and staff.
If the provider had continued to be registered with the Care Quality Commission, this location would have been placed into special measures. The areas where the provider must have made improvements are:
- Ensure staffing levels are sufficient to meet the needs and size of the patient group.
- Ensure safe medicine management systems are in place to protect patients.
- Take action to address identified concerns with infection prevention and control practice.
- Ensure recruitment arrangements include all necessary employment checks for all staff.
- Ensure all staff is supported by means of supervision and appraisal.
- Ensure audits of practice are undertaken, including completed clinical audit cycles.
- Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.
- Ensure systems are in place to respond to the concerns and complaints raised by patients and other stakeholders
- Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.
On the basis of the concerns identified at this inspection we took enforcement action. The CQC applied for and were granted an urgent order to cancel the registration of the provider. This was subject to appeal by the provider in the First Tier Tribunal. An initial appeal was made but subsequently withdrawn. The order stands and the provider’s registration has been cancelled.
As part of this action CQC liaised with NHS England to ensure measures were put in place to provide support, care and treatment for the patients affected by this closure. Patients previously registered with Goodwood Court Medical Centre were transferred to another local practice.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice