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Parkview Medical Centre Inadequate

We are carrying out a review of quality at Parkview Medical Centre. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 13 December 2019

During an inspection looking at part of the service

We carried out an announced focused inspection at Parkview Medical Centre (Dr R Kukar and Partners) on 13 December 2019.

The practice was previously inspected on 25 and 30 September 2019. Following that inspection, the practice was rated inadequate overall (inadequate in safe, effective, responsive and well-led and requires improvement in caring) and placed in special measures. We issued warning notices for breaches of Regulation 17 (Good governance) and Regulation 18 (Staffing). The practice was required to address these concerns by 20 November 2019. This focused inspection was to follow-up on the two warning notices.

We did not review the ratings awarded to this practice at this inspection.

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 found the provider had made improvements in providing safe services. In particular we found that the provider had made improvements to their systems and process in relation to safeguarding, safe recruitment, monitoring cervical screening, prescription stationery and patient safety alerts.

We found that the provider had made improvements for providing effective services. In particular the provider was able to demonstrate that core training had been undertaken by all clinical and non-clinical staff and they had implemented an appraisal and supervision schedule for their clinical staff. However, the practice was unable to demonstrate that role-specific training for their healthcare assistant was appropriate and up-to-date to deliver all their clinical duties and responsibilities.

We found the provider had made improvements in providing well-led services in relation to good governance and had implemented systems and process in response to the findings of our previous inspection.

The areas where the provider must make improvements are:

  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties

The areas where the provider should make improvements are:

  • Review the monitoring of immunisation status for non-clinical staff.
  • Review best practice guidance in relation to the management and control of prescription stationery.

The service will remain in special measures and this will be reviewed at a follow-up comprehensive inspection in line with our inspection criteria. This 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 are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 25 and 30 September 2019

During a routine inspection

We carried out an announced comprehensive inspection at Parkview Medical Centre (Dr Kukar and Partners) on 25 September and 30 September 2019 as part of our inspection programme.

We decided to undertake an inspection of this service following our annual review of the information available to us.

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.

We rated the practice as inadequate for providing safe services because:

  • The provider did not have clear systems and processes in place to keep patients safe and safeguarded from abuse.
  • The provider did not carry out recruitment checks in accordance with regulations.
  • The provider did not have systems and processes in place to manage and monitor cervical smear screening.
  • The provider did not monitor the prescribing of controlled drugs, for example, investigation of unusual prescribing, quantities, dose, formulations and strength.
  • The provider did not have clear systems and processes in place to manage prescription stationery.
  • The provider did not have effective systems in place to ensure that safety alerts were appropriately actioned.

We rated the practice as inadequate for providing effective services because:

  • There was no effective process in place to ensure that clinicians were aware of relevant and current evidence-based guidance and standards and were practising in line with guidance.
  • There was an overall lack of clinical monitoring and oversight to ensure effective care to drive quality improvement.
  • The provider was unable to demonstrate that all staff had the skills, knowledge and experience to carry out their roles through core and role-specific training, supervision and appraisal
  • Some performance data was significantly below local and national averages.

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

  • The practice could not demonstrate that patient privacy and patient information was consistently treated with confidentiality and in a way that complied with the Data Protection Act.
  • The practice could not demonstrate that they had sufficiently enabled people to express their views or had adequately sought or considered people’s preferences and choices when planning how care, support and treatment was delivered.

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

  • The service did not meet patients’ needs.
  • Patients could not access care and treatment in a timely way.
  • The practice planned and delivered services without consideration for the needs of its local population and patient population groups.

We rated the practice as inadequate for providing well-led services because:

  • The provider could not show that they had the capacity and skills to deliver high quality, sustainable care.
  • The overall governance arrangements were ineffective and unsafe.
  • The provider did not have clear and effective processes for managing risks, issues and performance.
  • We saw little evidence of systems and processes for learning, continuous improvement and innovation.

These areas affected all population groups, so we rated all population groups as inadequate.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Staff must receive the support, training, professional development, supervision and appraisals that are necessary for them to carry out their role and responsibilities.

(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 tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 29 November 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park View Centre for Health and Wellbeing (Dr R K Kukar & Partner) on 19 January 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 19 January 2016 inspection can be found by selecting the ‘all reports’ link for Park View Centre for Health and Wellbeing on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 28 November 2016 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 19 January 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed and the practice had acted upon the findings of our previous inspection in relation to patient safety.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Data from the Quality and Outcomes Framework (QOF) showed the practice had made some improvements to patient outcomes. However, some clinical indicators continued to show a negative variation from local and national averages.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities in a purpose-built primary health care centre shared with three other GP practices and community services and was well equipped to treat patients and meet their needs.
  • There was a leadership structure and staff felt supported by management.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Review the process in place for the receipt, dissemination, reviewing and acting upon patient safety alerts.
  • Monitor performance of the Quality and Outcome Framework (QOF) indicators specifically in relation to the cervical screening programme and patient outcomes in relation to the childhood immunisation programme.
  • Develop an on-going quality improvement programme to improve patient care.
  • Ensure all staff, including those undertaking revalidation through a professional body, have had an appraisal.
  • Evidence completion of training in the Mental Capacity Act and The Deprivation of Liberty Safeguards (DoLS) for all clinical staff.
  • Continue the drive to recruit patients to join the Patient Participation Group (PPG).

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection carried out on 19 January 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Parkview Centre for Health & Wellbeing (Dr R K Kukar & Partner) on 19 January 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

  • The practice had good facilities in a new purpose built primary health care centre shared with three other GP practices and community services and was well equipped to treat patients and meet their needs.
  • 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.
  • Data showed patient outcomes in relation to diabetes, mental health and cervical smears were significantly lower compared to the local and national averages.
  • We saw no evidence that quality performance measures, such as clinical audits, were driving improvement in performance to improve patient outcomes.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses but not all staff were included in the learning or distribution of minutes.
  • There was a clear leadership structure and staff felt supported by management.

The areas where the provider must make improvements are:

  • Undertake fire and environmental risk assessments and ensure staff participate in regular fire drills and know the location of the assembly point.

  • Ensure staff receive appraisal as is necessary to enable them to carry out the duties they are employed to perform.

  • Continue to work on sustaining and improving outcomes for patients with diabetes and increase the uptake of cervical screening and flu vaccinations for the over-65s.

  • Develop quality improvement processes, such as clinical audits, to drive improvement in performance to improve patient outcomes.

  • Evaluate the competence of a non-clinical member of staff reviewing and summarising patient hospital discharge letters, making amendments to medicines on the clinical system and managing repeat prescription requests and ensure appropriate training, written protocols and an auditable system of supervision is in place.

In addition the provider should:

  • Formulate a written strategy to deliver the practice’s vision.

  • Put in place a business continuity plan to deal with major incidents such as power failure or building damage.

  • Proceed with efforts to increase the patient participation group and meet more regularly to increase patients’ involvement in discussions and decisions relating to service provision.

  • Record verbal complaints in order to ensure shared learning from action taken and outcomes.

  • Ensure consistent and clear information for patients regarding the availability of clinical appointments and how to access them.

  • Ensure all clinical staff, especially those working outside core hours, are included in the dissemination of evidence based guidance, safety alerts and practice minutes.

  • Ensure all clinical staff have the appropriate IT knowledge and skills to effectively use the patient clinical system.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 31 July 2014

During an inspection looking at part of the service

This was a follow up inspection from our last inspection visit on 13 September 2013 where we found concerns. Since our last inspection the practice has moved locations but the registered person's and the staff team remain the same.

We spoke to eight patients and five staff members during our visit. Patients were very complimentary about the practice and staff felt they had a good relationship with their patients. Patients said they felt their doctor was caring, patient and understood their needs.

At our last inspection we had been concerned that the practice did not have adequate arrangements in place to deal with a medical emergency. At this inspection we found appropriate arrangements were in place for dealing with a medical emergency.

There was evidence of appropriate multi-agency working and the sharing of information for those patients in receipt of end of life and palliative care. All staff had received safeguarding adults training. Staff were aware of how to recognise and report any concerns or allegation of abuse.