The Care Quality Commission
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  • GP practice

Archived: Wyken Medical Centre

Overall: Inadequate read more about inspection ratings

Brixham Drive, Coventry, West Midlands, CV2 3LB (024) 7668 9149

Provided and run by:
Dr Hemendra Kashinath Pandya

Important: The provider of this service changed - see old profile

All Inspections

10 November 2015

During a routine inspection

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  • Medicines, including those for medical emergencies, were not regularly checked, some were out of date and others were not available if needed.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

24 February 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wyken Medical Centre on 24 February 2015. Overall, we rated the practice as inadequate.

Specifically, we found the practice to be inadequate for providing safe, effective, responsive and well led services. 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). It was good for providing a caring service.

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

  • Staff understood their responsibilities to raise concerns and to report incidents and near misses. Information about some incidents was recorded but systems for monitoring, reviewing and learning from these were not fully developed to ensure that patient safety was maintained.
  • There was no policy or structured guidance for staff to support and guide to ensure that patient safety was maintained.
  • The practice had not identified and assessed all risks associated with the health, safety and welfare of patients and staff. Action plans were either not in place or had not been followed up.
  • Patients were not protected from the risks of unsuitable staff being employed because recruitment policies and procedures did not ensure that the practice obtained all of the required information about new staff.
  • Although the practice had carried out some limited audits in respect of patient care we saw no evidence of completed clinical audit cycles to support improvement in performance and improve patient outcomes.
  • Whilst the practice received national guidance there was no evidence that the practice was using this to review their clinical practice, share learning or improve outcomes for patients.
  • Information about how to complain was available but the practice was not following its own policy in respect of responses to complaints.
  • A high proportion of patients were unhappy with the practice’s opening times and the availability of appointments. This was partly because the practice was only open in the mornings and closed at 1pm.
  • The practice had insufficient leadership capacity and limited formal governance arrangements. They had introduced a number of policies and procedures to govern activity since 2013 but some did not reflect all of the relevant legislation and guidance and some had not been followed in practice.
  • The practice had begun to hold a variety of meetings for clinicians and the whole staff team but these were not yet fully established.
  • The practice had taken notice of views expressed by patients in national NHS patient surveys but had not proactively sought feedback from patients themselves.
  • Patients said that the practice team provided attentive care which met their needs. They said they appreciated the fact that the staff knew them well. Patients told us staff were kind and treated them with compassion, dignity and respect.

The areas where the provider must make improvements are:

  • Operate effective recruitment processes and ensure that the required information is available in respect of all staff employed to work at the practice.
  • Ensure that effective arrangements for assessing, monitoring and improving the quality of the service at the practice are in place.
  • Ensure that effective arrangements for identifying, assessing and managing risks to patients’ and others’ health, safety and welfare are in place, including arrangements to manage any disruption to the practice’s ability to continue to deliver a service.
  • Ensure that systems are in place to ensure that all clinicians are kept up to date with national and local guidance and guidelines for the care and treatment of patients. This includes approaches for the care of patients at the end of life such as the Gold Standards Framework.
  • Ensure that audits of practice are undertaken and that these include full clinical audit cycles.
  • Ensure that learning from audits, significant events and complaints is taken into account in the assessment and delivery of care and treatment.
  • Provide other services such as the out of hours primary care services and the ambulance service with information about patients at the end of life or whose health might deteriorate suddenly to help ensure their needs and wishes are properly considered and taken into account and their care planned and delivered accordingly.

In addition the provider should:

  • Review the infection prevention and control policy to ensure it reflects current guidance and introduce systems for monitoring standards of general hygiene and cleanliness in the building. This should include a review of the work done so far in respect of precautions against legionella to ensure this is in line with guidance from the Health and Safety Executive.
  • Ensure that all new staff receive a structured induction.
  • Ensure that all staff are familiar with the requirements of the Mental Capacity Act 2005.
  • Consider improving access for patients by reviewing the times that appointments are available and providing online services such as appointment booking.
  • Develop a patient participation group to support the practice to work with the practice to improve services and the quality of care.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice