Archived: St Philips Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Philips Medical Centre on 2 August 2016. This was to follow up a comprehensive inspection we carried out on 12 November 2015 when we found the practice was not meeting the fundamental standards of quality and safety in a number of areas. Overall the service was rated as inadequate and placed in special measures.

St Philips Medical Centre drew up a special measures turnaround action plan to improve its performance in response to the findings of the previous inspection. At the follow up inspection we reviewed the practice’s progress in implementing this plan. The practice had made improvements in some areas but much of the action plan remained to be implemented. Overall, it had not addressed sufficiently concerns identified at our previous inspection and we identified additional concerns at our latest inspection. Overall the practice is rated as inadequate as insufficient improvement has been made.

Specifically, we found the practice to be inadequate for providing, safe, effective, and well-led services, and requires improvement for providing caring and responsive services.

The concerns which led to a rating of inadequate in safe, effective, and well-led apply to all population groups using the practice. Therefore, all population groups have been rated as inadequate.

Our key findings were as follows:

• Although the practice carried out investigations when there were unintended or unexpected safety incidents, there was limited documentary evidence that lessons learned were communicated throughout the practice to ensure that safety was improved. No minuted practice meetings had been put in place to facilitate this.

• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. There were continuing deficiencies in the systems and training for safeguarding, infection control, medicines management, dealing with medical emergencies and ensuring the safety of medical equipment.

• Action had been taken to improve recruitment processes, especially in relation to pre-employment checks, but not all the actions required had been implemented in full.

• There was still limited evidence of a multidisciplinary approach to patient care and treatment.

• The practice carried out clinical audit but there was no evidence of completion of the full audit cycle to improve patient outcomes.

• The practice promoted good health and prevention and provided patients with advice and guidance. However, the practice had not introduced care plans for older people and at risk groups.

• There was limited documentary evidence that learning from complaints had been shared with staff.

• Staff felt supported in their roles but there were continuing gaps in key areas of the training and appraisal they had received.

• There was limited progress in implementing systems to monitor and improve the quality and safety of the services provided.

The areas where the provider must make improvements are.

• Ensure care and treatment is provided in a safe way, through further improvements in the safety of infection control processes, medicines management and emergency and medical equipment.

• Ensure continuing gaps in staff training in safeguarding, infection control, and medical emergencies are addressed and completion of the induction process.

• Ensure patients are fully protected against the risks associated with the recruitment of staff, in particular in the recording of recruitment information and in ensuring all appropriate pre-employment checks are carried out and recorded prior to a staff member taking up post. Where Disclosure and Barring Scheme (DBS) checks are not carried out for some staff, this should be risk assessed and documented to evidence why.

• Ensure patients are protected from abuse and improper treatment through the completion of Disclosure and Barring Scheme (DBS) checks for staff who carry out chaperoning duties or risk assess the need and put in place mitigating arrangements.

• Put in place a formal process for disseminating NICE guidelines to all GPs working at the practice to ensure guidelines are implemented for the practice as a whole.

• Ensure there are appropriate arrangements in place to assess, monitor and improve the quality and safety of the services provided, including the introduction of formal governance arrangements and further development of the systems for assessing the quality of the experience of service users in receiving those services.

• Review the system in place for the use and storage of liquid nitrogen to ensure that the practice is fully compliant with the guidance, including a risk assessment for Control of Substances Hazardous to Health (COSHH).

In addition the provider should:

• Document in all cases the discussion and action agreed in communicating lessons learned from incidents and complaints to practice staff.

• Introduce care plans for patients over 75 and patients with chronic mental health issues.

• Make more systematic use of the information collected for QOF to review performance and improve quality.

• Introduce a programme of quality improvement including clinical audits and re-audits to ensure improvements in patient outcomes have been achieved improve.

• Foster greater participation in multidisciplinary working to co-ordinate patient care.

• Ensure locum (non-principal) doctors are informed of the outcome of hospital referrals or the results of tests they initiated.

• Review systems to improve the identification of carers and provide support.

• Develop a more robust planning process to address identified patient needs and determine the way services are delivered to meet all patients’ needs.

• Develop the practice vision and values further and ensure they are communicated to staff and patients.

This service was placed in special measures in February 2016. Insufficient improvements have been made such that there remains a rating of inadequate for providing safe, effective and well-led services. I have decided to place the service in special measures for a further period to allow the provider more time to implement planned improvements. The service 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 six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice