The Meads Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Meads Medical Centre on 3 December 2015. Overall the practice is rated as requires improvement.

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

• There was a lack of formal governance arrangements. Risks to patients and staff were not always identified, assessed and well managed.
• The practice had begun to make some improvements to their overarching governance framework which would support the delivery of good quality care.
• There was an effective system in place for reporting and recording significant events.
• Appropriate recruitment checks on key staff had not been undertaken prior to their employment.
• Staff felt well supported but had not always received training appropriate to their roles. Further training needs had not always been identified and planned. Some staff had not received an induction or regular appraisal of their performance.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Patient feedback showed that patients did not always feel satisfied with how they could access care and treatment.
• Patients reported that access to a named GP and continuity of care was not always available quickly, although urgent appointments were usually available the same day with a paramedic practitioner.
• Information about services and how to complain was available and easy to understand.
• 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 had sought some feedback from staff and patients, which it had acted on. However patient feedback via the national GP patient survey rated the practice considerably lower than others in several areas.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Ensure all necessary and relevant checks are undertaken for all staff prior to employment.
• Ensure criminal records checks via the Disclosure and Barring Service are undertaken for all staff who are assessed as requiring a check, such as staff who act as chaperones.
• Ensure there are formal governance arrangements in place, including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure that all patient identifiable information is held securely within the practice.
• Ensure rehearsals of fire evacuation procedures are undertaken.
• Ensure staff undertake training to enable them to undertake their role, including training in basic life support, the safeguarding of children and vulnerable adults, health and safety, fire safety, chaperoning, the Mental Capacity Act 2005 and infection control.
• Ensure that staff undertaking home visits to patients receive appropriate support and training.
• Ensure all staff to receive induction, regular supervision and appraisal.
• Ensure the hepatitis B status of all appropriate staff is established and that staff receive booster immunisations where required.
• Ensure staff have access to all required policies and procedures to support their role.
• Ensure improvements are made to patient access to the practice by telephone, their experience of making an appointment and waiting to be seen after their appointment time.

The provider should:

• Implement processes to establish a register of patients prescribed disease modifying antirheumatic drugs (DMARDs) in order to ensure their regular and ongoing review.
• Ensure cleaning schedules are agreed with external cleaning contractors.
• Provide written information within the practice to signpost carers to voluntary and support organisations.
• Continue to review patient feedback, particularly from the national GP survey in order to ensure continuous improvement relating to how patients felt they were treated by GPs and nurses and receptionists.
• Ensure clinical audits are used to promote continuous improvement and improve patient outcomes.

On the basis of some of the concerns identified at this inspection we are taking enforcement action. Where a practice is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected within six months after the report is published. If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a practice 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