The Care Quality Commission
  • Doctor
  • GP practice

Archived: Cornwallis Surgery

Overall: Inadequate read more about inspection ratings

Station Plaza Health Centre, Station Approach, Hastings, East Sussex, TN34 1BA (01424) 464752

Provided and run by:
Dr David Huw Jones

Important: The provider of this service changed. See old profile

All Inspections

7 & 11 September 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an unannounced focused inspection in response to concerns at Cornwallis Surgery on 7 September 2017, raised directly with CQC relating to patient access to and the quality of treatment, the management of prescriptions and delays in plans to transfer services to a new provider. We then conducted this inspection as a comprehensive inspection due to the findings of our focused visit and returned for a second unannounced visit on 11 September 2017.

During this inspection we identified risk of harm to patients due to insufficient staffing numbers and lack of effective governance processes and systems to identify, assess and monitor risk. This was a breach of legal requirement and the practice was rated inadequate providing safe, effective, caring, responsive and well-led services and overall. As a result of this inspection the Care Quality Commission has imposed urgent conditions on the registration of the service provider under Section 31 of the Health and Social Care Act 2008, in respect of all regulated activities for which they are registered. The urgent action was taken as we believe that a patient will or may be exposed to the risk of harm if we did not do so.

Our key findings across all the areas we inspected on 7 and 11 September 2017 were as follows:

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, the practice had not carried out appropriate recruitment checks on locum GPs.
  • Medicines and associated equipment were not always in date or stored securely and nursing staff tasked with monitoring did not have the time or capacity to do this. Blank prescriptions were not always stored securely.
  • The practice had systems in place for collecting and collating significant events and complaints and there was a culture of reporting incidents within the practice.
  • Staff reported incidents, near misses and concerns within the practice but there was no evidence of learning and communication with staff. Clinical incidents did not have the appropriate level of clinical input and staff were unsure about notifiable incidences and where the duty of candour applied.
  • Medicines reviews were not consistently taking place and patients were at risk because of this.
  • There were inconsistent reviews of high risk medicines and action to address risks were not always in line with national guidance. There was no system in place to deal with safety alerts.
  • Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.
  • There was poor management of long term conditions, with patients not consistently receiving regular reviews. Performance relating to the Quality Outcomes Framework (QOF) had deteriorated since the most recent published data due to a lack of leadership and oversight.
  • There were poor systems in place to keep clinical staff up to date and locum and nursing staff did not have dedicated time for clinical meetings or to complete training. GP locums had received inconsistent inductions and there was no evidence of clinical supervision.
  • Patients reported there was poor continuity of care and we saw that this had a detrimental impact on the quality of patient treatment and care.
  • The national GP patient survey results had further deteriorated in some areas of GP consultations since the previous inspection in April 2017.
  • We observed staff to be caring and compassionate in their interactions with patients.
  • Appointment systems were not working well so patients did not receive timely care when they needed it, particularly in relation to GP home visits. Patients continued to report some concerns about access to GP appointments and getting through to the practice by phone.
  • Complaints were recorded and generally responded to although there was a lack of leadership, clinical oversight, investigation and learning. Action was not always taken to improve the quality of care as a result.
  • The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.
  • Risks within the practice were not effectively managed and risk assessments were either unavailable or insufficient. Staff responsible for the management of risks and health and safety were not aware of the scope of these responsibilities.
  • Systems relating to the requirements of the Duty of Candour were informal. Staff responsible for recording and reporting safety incidents were unaware of the requirements.
  • Policies and procedures were not always accessible, clear or up to date.
  • There was a good deal of uncertainty amongst staff due to unclear changes in relation to the registered provider and a subsequent impact on the staffing structure within the practice.

As a result of these findings we sent a Letter of Intent notifying the provider (Dr David Huw Jones) of our concerns and that we were considering taking action using our urgent powers to impose conditions. Ten conditions were then imposed on the provider’s registration on 18 September 2017.

The provider negotiated a termination of contract with Hastings and Rother clinical commissioning group for 31 October 2017 and is in the process of cancelling their CQC registration.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

To Be Confirmed

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced focussed inspection at Cornwallis Surgery on 1 November 2016. The overall rating for the practice was requires improvement. The report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Cornwallis Surgery on our website at www.cqc.org.uk.

This inspection was an unannounced focussed inspection carried out on 18 April 2017 to confirm that the practice had taken steps to meet the legal requirements in relation to the breaches in regulations that we identified on our previous inspection on 1 November 2016 and to respond to a number of concerns sent to the Care Quality Commission. This report covers our findings in relation to those requirements and the review of the concerns raised.

Overall the practice is now rated as inadequate.

Our key findings were as follows:

  • We found that the practice did not have systems in place to manage medicines safely. Medicines were found to be out of date, medicines and computerised prescription forms were not always secure.
  • The practice did not have a system to ensure significant events were identified, recorded and reviewed. There was no evidence that the practice learned from incidents and disseminated information to staff.
  • Recruitment systems did not protect patients. For example staff were not risk assessed in relation to obtaining a DBS check and satisfactory information was not always available on the conduct of staff in previous employment.
  • The practice had not assessed the risk of the low staffing levels on the delivery of safe services to patients.
  • Patients told us that they had great difficulty in getting through to the practice on the telephone and struggled to get appointments. They felt they had no continuity in their care and treatment as they saw a different GP each time. Some patients felt the only way to be seen was to attend the practice and wait.
  • Staff did not always receive the training and support for their role and the safe delivery of care and treatment to patients.
  • Access to appointments was limited due largely to the limited availability of GP sessions.
  • The management of correspondence including hospital letters and results was unsafe.
  • Governance arrangements were not in place to mitigate risks to patients. Meetings were not held with staff to review the delivery of services.

Areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure systems are put in place to manage medicines safely. This must include the security and storage of computerised prescription pads and medicines.
  • Ensure a system is in place to identify, record and review significant events and demonstrate that the practice learns from incidents and disseminates information to staff.
  • Ensure effective recruitment systems are in place to protect patients. This must include all information required by regulation.
  • Ensure risks associated with low staffing levels and how they impact on the delivery of safe services to patients are reviewed and implement measures to mitigate these risks.
  • Ensure staff receive the training and support for their role and the safe delivery of care and treatment to patients. This must include regular clinical supervision, meetings and appraisals.
  • Ensure systems are in place to effectively manage correspondence including hospital letters and results.
  • Ensure they review the governance arrangements in the practice to include a programme of meetings and reviews to assess the quality and safety of the services provided.
  • Ensure the telephone and appointment system is reviewed and action is taken to improve these systems and patient access to appointments.

I am placing this service in special measures. Insufficient improvements have been made such that there is a rating of inadequate overall and for safe, effective, responsive and well-led services. Therefore we are taking action in line with our enforcement procedures. 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 six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

01 November 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

Cornwallis Surgery was placed in to special measures following a comprehensive inspection in July 2015 whilst being run by the previous provider. The current provider took over the running of the practice at the end of July 2015 and inherited the special measures status. In October 2015 the practice merged with another within the same building and the provider also took over three further surgeries in the Hastings area, Little Ridge, Shankill and Essenden Road. These are run as branch surgeries. We carried out an announced comprehensive inspection of Cornwallis Surgery on 9 February 2016. Breaches of legal requirements were found during that inspection within the effective and well-led domains. The practice was rated as requires improvement overall, requires improvement in the effective, caring and well-led domains and good in the safe and responsive domains. The practice was taken out of special measures.

After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:

  • Provide opportunities for staff to receive regular supervision and appraisal.

  • Seek and act upon feedback from patients in order to continually evaluate and improve services.

  • Provide staff with contracts of employment which reflected their current employment status.

Since the last inspection the practice had undergone significant changes in management. On 31 August 2016 the organisation that had been assisting with backroom support withdrew and on 01 September 2016 a new GP joined the current provider GP in the management team and took control of a re-organisation of the delivery of services as clinical lead GP.

At this inspection we found that

  • Staff received appraisals and supervision.

  • The practice had taken steps to obtain feedback from patients and had acted upon it.

  • All staff that had commenced employment since 01 September 2016 had a contract with Cornwallis Surgery. Staff that had commenced employment prior to 01 September 2016 had contracts with the name of their original employer on the contracts but their terms and conditions remained unchanged. Staff were clear who their current employer was and there was a clear staffing structure.

At this inspection we also focused on concerns raised by patients in the eight months since the last inspection.

Specifically concerns were that:

  • There was a lack of clinical staff available.

  • Locum GPs had to be available to advise several surgeries at the same time.

  • There was a backlog of investigation results to be processed.

  • Prescriptions were taken around from surgery to surgery by staff trying to get them signed by the GP.

  • Triaging was being carried out by unqualified staff.

  • A concern was raised that not all clinical staff were adequately trained for their roles.

  • There was poor telephone access for patients.

  • If there were no appointments available at their local surgery, patients were being asked to travel to another surgery in the group to receive care.

We found that:

  • Since 01 September 2016 the practice had employed two full time paramedic practitioners and two nurse practitioners and decreased the use of locum GPs to improve the continuity of care.

  • The new clinical lead GP had put in place several innovations and was working a significant number of additional hours to ensure that they were implemented successfully.

  • There was the equivalent of one whole time GP in regular locum cover per week. The practice used locums from a small pool of four locums that the GP felt were tried and trusted.

  • Since 01 September 2016 locum GPs were only asked to cover the patients in the surgery that they were working in for that session.

  • Investigation result processing was up to date and there was an effective system in place for the processing of investigations.

  • The practice had put in place a telephone results clinic for two evenings a week when patients could book a telephone appointment to discuss test results with the clinical lead GP.

  • There was a pharmacy technician employed who managed the repeat prescription service. There was an electronic prescription service available.

  • A new system of ‘on the day’ appointment allocation had been introduced referred to as “management streaming and navigation” and managed by a trained member of the administration staff working to a strict protocol. Any issues outside the protocol were referred immediately to the clinical lead GP via the practice on screen messaging service.

  • We found that clinical staff were aware of their limitations and worked within their competencies.

  • All patients were now registered at the Cornwallis site. Where available patients would be offered an appointment at their nearest branch, if one was not available then they would be offered an appointment at one of the other surgeries in the group if appropriate.

The areas where the provider must make improvement are:

Ensure that there is a risk assessment and sustainable written contingency plan in place to ensure the safe and effective provision of services and meet the needs of the patient population should the clinical lead GP or other key staff be unavailable to do so.

The areas where the provider should make improvement are:

To continue to seek out, and act on, patient and staff feedback in particular in relation to the efficiency of the telephone system, access to appointments and continuity of care.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

9 February 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cornwallis Surgery on 9 February 2016. Overall the practice is rated as requires improvement.

We found that many improvements had been made since our previous inspection in July 2015 when the practice had been rated as inadequate and was placed into Special Measures.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Staff had not received regular supervision and appraisal of their performance.
  • Staff had not received up to date contracts of employment. Some staff were unclear about their employment status and the organisational structure.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information on the practice website was out of date and did not reflect current service provision. Up to date information was available within the practice.
  • Information about how to complain was available within the practice and was easy to understand.
  • Patients said they were able to access appointments when they needed one. Urgent appointments were available on the same day. However, patients told us there was a high level of use of locums within the practice.
  • 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 informally. 

  • Public meetings had been held at which changes in the structure of the service were discussed and patient questions addressed.

  • The practice had not carried out a survey or analysis of patient feedback on the services provided.

  • The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

  • Provide opportunities for staff to receive regular supervision and appraisal.
  • Seek and act upon feedback from patients in order to continually evaluate and improve services.
  • Provide staff with contracts of employment which reflect their current employment status.

The areas where the provider should make improvements are:

  • Ensure the updating of recruitment checks for all staff.
  • Continue to review patient treatment outcomes to ensure continuous improvement. For example, the management of patients with diabetes and COPD and the practice’s uptake for the cervical screening programme.
  • Update the practice website to ensure accurate information is available to patients which reflects the current service provision.
  • Ensure registration with the Care Quality Commission accurately reflects the services provided.

I confirm that this practice has improved sufficiently to be rated as requires improvement overall. The practice will be removed from special measures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice