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Jarvis Medical Practice - GPCC Requires improvement

Reports


Inspection carried out on 9 June 2020

During an inspection looking at part of the service

We carried out a focused inspection of Jarvis Medical Practice on 9 June 2020. We announced the inspection the previous day.

We had previously inspected the practice on 1 March 2019 and the practice was given an overall rating of requires improvement with the following key question ratings:

Safe – requires improvement

Effective – requires improvement

Caring – good

Responsive – good

Well-led – requires improvement

All the population groups were rated requires improvement.

We would usually have carried out a full comprehensive inspection within 12 months of the previous report being published, which was on 23 April 2020. Ratings would have been reviewed at this time.

We have paused our routine inspections due to Covid-19, but our regulatory role and core purpose of keeping people safe has not changed.

We received information of concern about Jarvis Medical Practice. The risk to patients was formally assessed and it was determined that an inspection should be carried out. This was a focused inspection about specific areas of concern relating to patient safety.

As general practice has adapted its ways of working since Covid-19 began, and particularly since lockdown began on 23 March 2020, we looked at records from prior to and following this date.

We found that:

  • The system to identify patients in urgent need of attention was not effective.
  • Records were unclear so it was not possible to always determine what had taken place during a consultation. Conflicting information had been recorded for single consultations.
  • Records were not always written contemporaneously and we saw evidence of records being amended.
  • Blood tests required for patients taking certain medicines, or with certain conditions, did not routinely take place.
  • It was not clear why some medicines had been prescribed, and side-effects were not always noted as being discussed.
  • Examinations did not always take place for patients attending face to face appointments with physical symptoms.
  • Patients at risk of diabetes were not always identified.
  • Requests for home visits were not always actioned. We saw other examples of requests not being actioned for several days with no recorded explanation or assessment of urgency.
  • The issues we identified during our focused inspection had not been identified by the partners.

As this was a focused inspection due to specific concerns raised, we have not awarded an overall rating or a rating for any key question.

Due to the seriousness of the issues we found relating to patient care and safety we issued a Notice of Decision to suspend the registration of Jarvis Medical Practice for a period of four months on 11 June 2020. The notice took immediate effect. There is a process where the action we have taken could be appealed. We shared our findings with NHS Oldham Clinical Commissioning Group (CCG). They took immediate steps to ensure patients had continuing access to a GP service.

Details of our findings and the evidence supporting our ratings 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 1 March 2019

During a routine inspection

We carried out an announced comprehensive inspection at Jarvis Medical Practice - GPCC on 1 March 2019 as part of our inspection programme. The practice had previously been inspected on 4 March 2015 and had been rated good in all areas at that 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 have rated this practice as requires improvement overall and requires improvement for all population groups.

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

  • Not all staff had completed safeguarding training and the safeguarding policy had not been fully personalised.
  • There were gaps in staff recruitment checks. For example, we saw no evidence that a full work history was always obtained or that gaps in employment history were not queried.
  • The infection control audit stated that all staff had received training in infection control, but this was not the case.
  • Significant events were not managed in a consistent way.
  • The practice health and safety risk assessment had not been completed, although the building management team had completed a separate one.
  • A two week wait referral from five working days prior to the inspection had not been actioned.

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

  • There were gaps in staff training, including mandatory training.
  • Training information for locum GPs was not routinely kept. Training information for the business manager, who started work at the practice over two years ago, was in the form of a letter from their previous employer.
  • Although appraisals had been carried out it was difficult to tell when this had been done and there was limited input from some staff in their appraisals.
  • Where audits had identified a decrease in performance this was not explored, and further audit dates not arranged.

We rated the practice as good for providing caring services because:

  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.

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

  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

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

  • Governance procedures were not always effectively managed. For example, the practice’s health and safety risk assessment had not been completed, the safeguarding policy was not personalised to the practice, and the business plan was for a different practice.
  • Clinical audits were not always effective or repeated appropriately.
  • The procedure for managing significant events did not ensure learning took place. Significant events were not reviewed at a later date.
  • Training was not up to date and training information for the locum GPs was not sought.

These areas affected all population groups so we rated all population groups as requires improvement.

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.
  • Ensure recruitment procedures are established and operated effectively so only fit and proper persons are employed. Ensure specified information is available regarding each person employed.

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 4 March 2015

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 Jarvis Medical Practice on 4 March 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for the 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.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training had been identified and planned.
  • 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 to patients.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients.
  • The practice have a good understanding of the cultural needs of patients, for example, providing guidance and support to people with diabetes.

We saw several areas of outstanding practice including:

  • The practice worked closely with the local community to promote health awareness. They worked closely with local community groups to ensure healthcare information reached groups of patients from black and minority ethnic communities. The GP worked closely with the local mosque and regularly spoke at information sessions to groups of the community on topics such as diabetes, forced marriage and domestic violence.

  • The practice was committed to health promotion and prevention with a strong emphasis on improving patient’s well-being and lifestyle. The GP was working with Public Health England on providing dietary advice for patients who followed an Asian diet and the implications this might have for people’s diabetes condition. They also presented a weekly programme on Sky television to Pakistan and to the local Pakistani community in Oldham.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • A programme of more frequent clinical audits should be developed to demonstrate positive outcomes for patients.
  • Pre-employment checks should be in place before staff are employed.
  • A training record of all staff employed or contracted to work sessionally at the practice should be kept, for example, nurses, GPs and locum GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice