Charlton House Medical Centre

We carried out an announced inspection at Charlton House Medical Centre on 8 June 2021, with medical records searches carried out on 26 May and 18 June 2021. Overall, the practice is rated as Inadequate.

Safe - Inadequate

Effective - Inadequate

Caring – Requires Improvement

Responsive - Inadequate

Well-led - Inadequate

We previously inspected Charlton House Medical Centre on 9 January 2018 at which time we rated it as Good for all key questions and Good for all population groups.

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

Why we carried out this inspection

This inspection was carried out as a result of a concern being received about the practice.

The key questions inspected were: Safe, Effective, Caring, Responsive and Well-led

How we carried out the inspection/review

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 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 short 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 and
• information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall, with a rating of Inadequate for Safe Effective, Responsive and being Well-led and a rating of Requires Improvement for providing Caring services. We also rated the practice as Inadequate for all population groups.

We rated the practice as Inadequate for providing Safe services because:

• The practice did not have a nominated lead member of staff for its adult safeguarding policy;
• There was a lack of evidence GPs and staff were trained to appropriate levels for adult and children safeguarding;
• The practice was unable to provide us with evidence of appropriate recruitment checks carried out for all staff including locums;
• The practice failed to provide evidence that all clinical staff registrations were regularly monitored;
• Medical equipment calibration tests had not been carried out within the last 12 months;
• Although it had a Fire Safety Policy, the practice was unable to provide us with evidence of having carried out a fire risk assessment within the last 12 months. Nor was there any evidence of when the fire safety policy had been implemented or of any reviews and updates;
• The practice was unable to provide evidence of a premises/security risk assessment within the last 12 months;
• It was unable to provide evidence of health & safety risk assessments within the last 12 months;
• The practice it did not provide us with evidence that all staff had received infection prevention and control training;
• The practice had not acted on all issues identified in its most recent infection prevention and control audit;
• The infection prevention and control policy did not specify the need to notify Public Health England of suspected notifiable diseases;
• The GP locum pack did not contain sufficient information;
• Staff had not completed all mandatory training;
• There were no practice meetings;
• The practice was not adhering to its policy for making referrals for patients with a suspected diagnosis of cancer;
• There was a lack of monitoring for patients being prescribed high-risk medicines;
• Not all patients’ medical records were kept up to date and accurate.
• The practice had a checklist in order to regularly check its stock of emergency medicines, however this had not been completed since November 2020. Accordingly, we were not assured it had checked its stock of emergency medicines since November 2020;
• The practice held stocks of emergency medicines which contained some out of date medicines. The emergency medicines it kept did not include some medicines we would normally expect a GP practice to hold;
• Only the lead GP attended clinical meetings and there was no evidence of a system to disseminate information including clinical updates.

We rated the practice as Inadequate for providing Effective services because:

• Only the lead GP had attended clinical meetings and there was no evidence other clinicians were invited or required to attend. There was no evidence the notes of these meetings were distributed to other clinicians to ensure they remained up to date;
• On review of the practice’ medical records reviews we found evidence of a number of patients not receiving necessary blood test monitoring as required by national guidelines;
• Notes we reviewed showed some patients were not receiving timely medicines reviews;
• Some patients notes we reviewed showed they were being over prescribed medicines contrary to national guidance.
• The practice did not always carry out structured annual medicines reviews for all patients who would benefit from one;
• The practice’ performance for its childhood immunisations programme was significantly below the WHO minimum 90% for five of five childhood immunisation uptake indicators CQC reviews;
• Its performance for its cervical cancer screening programme was significantly below the 80% uptake national target;
• The practice had not undertaken any complete (two or more cycle) audits as a means of driving quality improvement;
• Staff employed at the practice had not completed all mandatory training which we would normally expect staff in a GP practice to have completed at the time of commencing employment.

We rated the practice as Requires Improvement for providing Caring services because:

• The practice was below local and national averages for three out of four indicators relating to patient satisfaction as measured by the National GP Patient Survey relating to: being listened to, being treated with care and concern and their overall experience of the practice.

We rated the practice as Inadequate for providing Responsive services because:

• The premises were in a poor decorative state and were without adequate arrangements for access to the building and some clinical rooms for patients with mobility issues;
• Patients were not able to access care and treatment in a timely way;
• There was no evidence of learning from complaints, or that they were used to drive quality improvement at the practice.

We rated the practice as Inadequate for being Well-led because:

• There were limited standing agendas for clinical meetings to ensure full discussion of all issues, including review of incidents, complaints and recent MHRA alerts.
• Clinicians were not required to attend clinical meetings and there was no provision for distribution of clinical meeting minutes to all clinicians;
• We were not assured that all clinicians kept up to date with national medical alerts and changes in guidance, or of any changes to practice policies and procedures;
• There was a lack of clinical oversight or supervision with no peer reviews of clinicians’ work.
• The practice was not participating in clinical audit as a means of driving learning and improvement.
• The locum pack provided to locum GPs working at the practice contained insufficient detail to enable them to carry out their responsibilities;
• The practice was not recording, investigating or learning from all relevant significant events;
• We were not assured the practice learnt from and made changes to its policies and procedures as a result of complaints;
• We were not assured the practice staff undertook regular training to enable them to perform their roles.
• Some practice policies showed no evidence of creation date or of regular review and updating;
• There was no effective system for the management of patients being prescribed high risk medicines, including a lack of regular blood test monitoring contrary to national guidance;
• The practice did not have a system to ensure it recorded treatment and monitoring patients received in secondary care;
• Staff we spoke to had worked for the practice for less than 12 months so had not received an annual review. In addition, the practice told us it only employed staff on fixed term contracts.
• Although the practice was offering a range of appointment options, the results of the GP Patient survey showed patients were not satisfied with access;
• The practice was not conducting regular audits of the appointment system to improve patient access;
• There was no evidence of the practices performance being discussed between staff and management;
• The practice ran the friends and family survey, however there was no evidence it used the results to make improvements.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients;
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care;
• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

• Provide all staff with all mandatory training in line with national guidance and guidelines.
• Work to improve uptake of its childhood immunisations programme for the benefit of eligible patients;
• Work to improve uptake of its cervical screening programme for the benefit of eligible patients;
• Work to repair and improve the interior decoration of the premises and facilities to ensure they are in an appropriate state of repair for the benefit of all service users;
• Work to provide appropriate access into and around the practice for people with mobility issues.

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 tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care