Archived: Wyken Medical Centre

Updated 4 February 2016

Wyken Medical Centre is situated on the outskirts of Coventry. It has around 2,100 patients and has a catchment area of approximately a one mile radius around the practice. The practice is in purpose built premises. The practice has a free car park with disabled spaces nearest to the entrance. There is a pharmacy nearby.

The practice ownership changed during 2013 when one of two partners retired and the other took over the practice as a sole provider. The practice was subsequently re-registered with the Care Quality Commission (CQC) in September 2014. When we inspected in February 2015 the GP told us that when they took over sole responsibility for the practice they had little experience of the governance, administration and financial aspects of managing a GP practice. This was because the retired partner had taken full responsibility for these aspects of running the practice. These were areas where they and the practice manager, also new to their role at that time, had needed to build their knowledge and experience together.

The practice has one male GP and one practice nurse. The GP and nurse are supported by a practice manager and three receptionists.

The practice has a patient participation group (PPG), a group of patients registered with a practice who work with the practice team to improve services and the quality of care. The PPG was established in July 2015 and held its first meeting in October 2015.

Since our previous inspection in February 2015 the practice had changed from a Primary Medical Services (PMS) contract with NHS England to a General Medical Services (GMS) contract.

Wyken Medical Centre has a website which was set up after our inspection in February 2015 2015.

The practice is open Monday to Friday between 9am and 12.30pm, from 4pm to 6.30pm on Mondays and Wednesday and from 1pm to 3.30pm on Fridays. The practice does not provide extended hours appointments or out of hours services to their patients. Out of hours services are provided by Care UK a national healthcare organisation. When the practice is closed the telephone diverts patients to an answering service run by Patient Care Services, part of the West Midlands Ambulance Service. This provides a recorded message telling patients to call the practice in surgery opening hours for appointments and prescriptions, to dial 999 for medical emergencies or to hold the line to speak with a member of the Patient Care Services team. The GP explained that this service transfers calls to them if a patient needs to be seen when the practice is closed during core contracted hours of 8 am to 6.30pm. They told us they often visit patients at home on these occasions.

We first inspected Wyken Medical Centre on 24 February 2015 with a GP specialist advisor. We found that the practice was in breach of Regulations 12(2)(i), 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We judged the practice to be inadequate in respect of providing services which were safe, effective, responsive and well led. We judged that it was good in providing a caring service. The overall rating for the service was inadequate and we placed it in special measures. This was for a period of six months during which time the provider was expected to improve the practice to meet the required regulations and fundamental standards. Special measures are designed to ensure a timely and co-ordinated response to practices found to be providing inadequate care that gives them support from NHS England and the Clinical Commissioning Group (CCG). Practices can choose to get further peer advice and support from the Royal College of General Practitioners. Being placed into special measures represents a decision made by CQC that a practice has to improve within six months to avoid having its registration cancelled.

We carried out this comprehensive inspection to follow up the findings of the previous inspection and to gain an up to date picture of whether the service was providing safe, effective, caring, responsive and well led services and meeting the fundamental standards set out in the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the inspection on 10 November 2015 we found that the practice had made a range of improvements. However, we also found areas of concern which meant that the overall rating remained inadequate. We are therefore taking action in line with our enforcement procedures.

Updated 4 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wyken Medical Centre on 10 November 2015. Overall the practice is rated as inadequate.

We first inspected Wyken Medical Centre on 24 February 2015 with a GP specialist advisor. We found that the practice was in breach of Regulations 12(2)(i), 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We judged the practice to be inadequate in respect of providing services which were safe, effective, responsive and well led. We judged that it was good in providing a caring service. The overall rating for the service was inadequate and we placed it in special measures. This was for a period of six months during which time the provider was expected to improve the practice to meet the required regulations and fundamental standards. Special measures are designed to ensure a timely and co-ordinated response to practices found to be providing inadequate care that gives them support from NHS England and the Clinical Commissioning Group (CCG). Practices can choose to get further peer advice and support from the Royal College of General Practitioners. Being placed into special measures represents a decision made by CQC that a practice has to improve within six months to avoid having its registration cancelled.

Our key findings across all the areas we inspected on 10 November 2015 were as follows:

• Since the previous inspection in February 2015 the practice had made improvements in respect of a number of safety related areas including staff recruitment, fire safety and learning from significant events.

• Medicines, including those for medical emergencies, were not regularly checked, some were out of date and others were not available if needed. Medicines were not all stored appropriately and some medicines prescribed for individuals were being used for other patients.
• The GP was not familiar with the practice’s arrangements for managing safety alerts or for managing safety at the practice including arrangements for medical emergencies and major incidents.
• Infection control was not proactively monitored although improvements had been made during 2015.
• The GP and practice nurse did not have clinical meetings to share and review clinical guidance and reflect on how they needed to take this into account in patient care.
• There was no established system of clinical audits to ensure that care and treatment was provided appropriately and outcomes for patients monitored and improved.
• Whilst some national data showed the practice performed well in some areas of care and treatment this was mixed and we found examples of patients with long term conditions whose care had not been reviewed for three years.
• The GP did not understand their responsibilities under the Mental Capacity Act 2005. This is the legal framework they should use in respect of patients who may lack capacity to make particular decisions for themselves.
• Patients were very positive about the service they received at the practice. They said they were treated with compassion and dignity and spoke highly of the care and treatment they received.
• The practice had increased its opening hours and now provided afternoon appointments three days a week. This had been welcomed by patients and most were now satisfied with the practice’s opening hours.
• The GP had limited awareness of their responsibilities across a range of clinical and non-clinical areas and was over reliant on the practice manager to support the overall management of the service.
• There was a lack of clarity about lead roles and responsibilities at the practice relating specifically to safeguarding, infection control and dealing with patient referrals.

The areas where the provider must make improvements are:

• Introduce robust processes the safe management of medicines.
• Review availability of medicines and equipment to manage medical emergencies and carry out a risk assessment in respect of medicines they decide not to stock.
• Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.
• Ensure that all clinicians understand their responsibilities in respect of the Mental Capacity Act and other legislation and guidelines relating to consent.
• Carry out clinical audits including re-audits to ensure improvements have been achieved.
• Improve formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.
• Clarify the leadership structure and staff roles and responsibilities and ensure there is leadership capacity to deliver all improvements

The areas where the provider should make improvement are:

• Review the practice’s infection control procedures and protocols giving due regard to guidelines issued by the Department of Health - The Health and Social Care Act 2008: ‘Code of Practice about the prevention and control of infections and related guidance’

• Review their recruitment policy to fully reflect the requirements of Regulation 19(3) and Schedule 3 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the inspection on 10 November 2015 we found that insufficient improvements have been made such that there remains a rating of inadequate overall for this practice. The key areas of safe, effective and well led are rated inadequate and the responsive and caring are rated requires improvement. The ratings for all population groups remain inadequate. We are therefore taking action in line with our enforcement procedures.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 4 February 2016

The provider was rated as inadequate for safe, effective and well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice team was small which limited the range of services it could offer. However, they worked in partnership with other professionals including health visitors, district nurses and specialist services such as specialist diabetes and COPD nurses and the diabetes retinal screening service.

• Data for a number of long term conditions showed outcomes for patients were mixed. For example, the practice had achieved better than the CCG and national average for some aspects of diabetes care but worse for others.

• The practice did not have a structured system for arranging patients’ routine reviews.

• Information made available to out of hours and ambulance services to help ensure that patients at the end of their lives received the care and treatment they wished in the place of their choosing.

• The practice had a palliative care register and met with other health professionals to discuss the needs of those patients. These meetings were not attended by the GP as would be expected.

Updated 4 February 2016

The provider was rated as inadequate for safe, effective and well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice had systems to identify and follow up children living in disadvantaged circumstances and who were at risk. The practice team knew local families well and liaised with health visitors and school nurses although the GP did not routinely take part in multi-disciplinary meetings.

• Childhood immunisation rates were comparable to the CCG averages and in a number of cases higher

• Some appointments were available outside of school hours on two days a week when the practice was open between 4 and 6.30pm.

• The premises were suitable for families, children and young people because there was ample car parking and space in the practice for prams and pushchairs.

Updated 4 February 2016

The provider was rated as inadequate for safe, effective and well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The GP and practice nurse provided home visits for those patients who were unable to come to the practice due to poor health or limited mobility. This included visits for annual health checks, flu vaccinations and medicines reviews or due to a specific health need.

• The percentage of people aged 65 or over who received a seasonal flu vaccination in 2013/14 was lower than the CCG and national averages but the practice was working to improve this.

• The GP visited patients who had been discharged from hospital within two weeks and referred older patients discharged from hospital to the community matron and/or the district nurse team.

• The practice did not provide health checks for over 74 year olds but did offer pneumonia and shingles vaccinations.

• Information was made available to out of hours and ambulance services to help ensure that patients at the end of their lives received the care and treatment they wished in the place of their choosing.

• The practice had a palliative care register and met with other health professionals to discuss the needs of those patients. These meetings were attended by the practice manager and practice nurse.

Updated 4 February 2016

The provider was rated as inadequate for safe, effective and well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The age profile of patients at the practice was mainly those of working age and young people but the services available did not fully reflect the needs of patients unable to go to the practice in the mornings.

• The practice closed at 1pm two days a week and did not provide early morning or evening appointments. The practice had introduced two late afternoon (4pm to 6.30pm and 1pm to 3pm) surgeries each week.

• The practice introduced a website in July 2015 but this did not yet provide the facility for patients to book appointments or order repeat prescriptions online.

• Health promotion advice was offered at the practice and links to Patient UK information were available on the practice website.

Updated 4 February 2016

The provider was rated as inadequate for safe, effective and well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Available data showed that the practice’s performance in respect of monitoring the health of patients experiencing poor mental health was variable. For example they performed well for providing care plans but their performance for monitoring blood pressure was lower than the CCG and national averages.

• The practice referred patients with anxiety and depression to Improving Access to Psychological Therapies (IAPT) service. A counsellor from the service visited the practice regularly to see patients.

• The percentage of patients with a diagnosis of dementia who had received a face to face review in the preceding 12 months was 2.3% above the CCG average and 0.6% above the national average. Specific health checks had been completed for 75% of all the practice’s patients with a diagnosis of dementia with no exception reporting.

• The practice referred patients thought to have dementia to the local mental health team, but explained that patients experienced delays in obtaining appointments.

Updated 4 February 2016

The provider was rated as inadequate for safe, effective and well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice was situated in an area where there was some social and economic deprivation but had no homeless patients registered there.

• The practice team were aware of the pressures under which many of their patients lived, for example in respect of housing and employment issues.

• The practice had a very small number of patients with a learning disability and called them to have annual health checks.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. There was a lack of clarity about which member of the team was the lead person for safeguarding.