Archived: Vicarage Road Medical Centre

Letter from the Chief Inspector of General Practice

This practice is rated as Inadequate overall. (Previous inspection March 2017 – Requires improvement)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? - Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. As we found three key questions to be inadequate, they applied to all population groups and this means that each population group is also rated as inadequate:

Older People – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) – Inadequate

This inspection was an announced comprehensive inspection on 23 and 28 November 2017, carried out to confirm that the practice had carried out their plan to meet the legal requirements in relation to breaches in regulation that we identified in our previous inspection on 7 March 2017. There were breaches in medicines management, safe care and treatment, infection control, governance and complaints and significant events processes. The inspection was carried out across two days due to insufficient time made available for us to interview the GP on the first day of this inspection.

At this inspection in November 2017 we found:

• There was no clinical oversight from the GP in the Quality Outcome Framework exception reporting process.

• Childhood immunisation uptake was below national averages.

• On occasions arrangements for alternative clinical cover were not in place.

• Data from the national GP patient survey showed that patients rated services provided by the nurse and access to appointments below the Clinical Commissioning Group (CCG) and national averages.

• The practice did not have up to date personnel records for locum staff members such as assurance of up to date medical defence union cover.

• There were limited policies and processes to govern activity and most policies that were available had not been reviewed in the last 12 months.

• There was minimal management oversight in staff training and completed training such as child safeguarding and infection control was out of date.

• The processes for sharing learning from significant events and complaints with all relevant staff members was not effective.

• The business continuity plan was not sufficient. The previous inspections CQC rating was not displayed.

• Quality improvement was not a priority among the leadership team.

• The practice had clear systems to manage patient safety alerts.

• Three percent of the patients had been identified as carers and there was a carers’ champion who supported them.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• There was an active patient participation group.

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

• Ensure care and treatment is provided in a safe way to patients.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• Ensure the most recent CQC rating is clearly displayed.

The areas where the provider should make improvements are:

• Work to improve the uptake of childhood immunisations.

• Work to improve patient satisfaction with services provided.

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 population group, 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.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Vicarage Road Medical Centre on 7 March 2017. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events, however there was no evidence that learning and outcomes from events were shared with all relevant practice staff members.

• The practice could not demonstrate how it acted on patient safety alerts.

• The practice did not adequately monitor patients on high risk medicines before issuing prescriptions.

• The practice held stocks of the controlled drug diamorphine, we found that this was not effectively managed and monitored, however post inspection we were provided with evidence that the practice disposed of this medicine.
• The practice systems to minimise risks to patient safety were not effective, there was a fire safety risk assessment but no fire drills were carried out and the practice had a legionella risk assessment but had not carried out the actions that was identified as a result.

• Data from the Quality and Outcomes Framework showed patient outcomes were comparable to the local and national averages, however the practice had high levels of exception reporting in many areas and had not addressed this.

• The practice achieved low GP patient satisfaction scores in several aspects of care.
• Information about services and how to complain was available; however the practice had only recorded one complaint in the last 12 months and had no mechanism for recording verbal interactions.
• The practice used disposable clinical equipment, we found out of date swabs, vaginal and male urethral speculums and sterile sodium chloride solution. These were disposed of in our presence.
• Staff were aware of current evidence based guidance but there was no system to monitor their use.
• All staff within the practice had a sound knowledge about safeguarding and were trained to the levels sufficient for their role.
• There was evidence of quality improvement including clinical audit.
• The practice had identified 3% of its patient list as a carer and had carers’ lead that supported carers in the practice.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on. This included feedback from the active patient participation group.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

• Introduce effective processes to share learning and outcomes including from significant events and from patient safety alerts.

• Implement systems that allow for the timely monitoring and disposal of expired disposable clinical equipment.

• Ensure the new practice system for monitoring and managing patients on high risk medicines are embedded in the practice.

• Review the system for exception reporting that includes clinical oversight of the process.

• Review the system for capturing and recording complaints, including verbal interactions.

The areas where the provider should make improvement are:

• Continue to carry out the actions identified in the legionella risk assessment.

• Put systems in place for regular fire drill testing.

• Continue to work to improve GP patient satisfaction scores and increase patient access to a GP as well as responding to patient feedback.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice