Medway Medical Centre

We carried out an unannounced comprehensive inspection at Medway Medical Centre on 5 and 6 September 2023. Overall, the practice is rated as Inadequate.

The ratings for each key question are:

• Safe – Inadequate
• Effective – Inadequate
• Caring – Requires Improvement
• Responsive – Inadequate
• Well-led – Inadequate

The full comprehensive report can be found by selecting the ‘all reports’ link for Medway Medical Centre on our website at www.cqc.org.uk.

Why we carried out this inspection:

We carried out an unannounced comprehensive inspection at Medway Medical Centre on 5 and 6 September 2023 under Section 60 of the Health and Social Care Act 2008, following information of concern. The report covers our findings.

How we carried out the inspection:

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Requesting evidence from the provider.
• A site visit.
• Completing clinical searches on the practice’s patient records system in line with all data protection and information governance requirements.
• Reviewing patient records to identify issues and clarify actions taken by the provider.

Our findings:

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.
• Information from the provider, patients, the public and other organisations.

We found that:

• The practice’s systems, practices and processes did not always keep people safe and safeguarded from abuse.
• To ensure patient safety, improvements were required to the practice’s systems and processes that ensured: the effective management of infection prevention and control; the assessment, monitoring and management of risks; the effective arrangements for managing medicines; learning and making improvements when things went wrong; complaints were being used to improve the quality of care; the practice culture effectively supporting high quality sustainable care; overall governance arrangements being effective.
• Staff did not always have the information they needed to deliver safe care and treatment.
• Patients’ needs were not always assessed, and care and treatment were not always delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
• Published results showed uptake rates for childhood immunisations were below the target of 90% in all the 5 indicators as of 31 March 2022 and the practice’s uptake for cervical screening as of March 2023 was 59% (significantly below the 80% coverage target for the national screening programme).
• The practice was unable to demonstrate that staff had the skills, knowledge and experience to carry out their roles; that staff treated patients with kindness, respect and compassion and respecting patients’ privacy and dignity.
• Feedback from patients was negative about the way staff treated people and national GP patient survey published in July 2023 was below local and England averages in all 5 indicators (significantly so for 2 of these relating to access).
• Services did not always meet patients’ needs and people were not always able to access care and treatment in a timely way.
• Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care and whilst the practice had a clear vision, it was not supported by a credible strategy to provide high quality sustainable care.
• The practice did not always act on appropriate and accurate information and they did not involve the public, staff and external partners to sustain high quality and sustainable care.
• There was little evidence of systems and processes for learning, continuous improvement and innovation.

The areas where the provider must make improvements as they are in breach of regulations are:

• The provider must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• The provider must 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.

Due to the seriousness of the breaches of the Health and Safety Act 2008 (Regulated Activities) Regulations 2014 found at this inspection, we took urgent action and imposed the following conditions on the provider’s registration with CQC:

The registered person must not register any new patients at Medway Medical Centre (including Railside branch surgery and Upper Canterbury Street branch surgery) without the written permission of the Care Quality Commission unless those patients are newly born babies or are newly fostered or adopted children of patients already registered at Medway Medical Centre.

The registered person must submit to the Care Quality Commission, on a monthly basis, a written report of progress made against the action plan submitted to the Care Quality Commission on 25 September 2023.

We also issued 2 Warning Notices in line with our enforcement processes for breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 17 - Good governance and Regulation 18 - Staffing.

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 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.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

Please refer to the detailed report and the evidence tables for further information.