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Archived: Now GP Requires improvement

This service was previously registered at a different address - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 2 April 2020

We carried out an announced focused inspection at Now Healthcare Group on 28 February 2020. We also attended the service on the 2 March 2020 to collect further evidence.

The practice was previously inspected on 8 October 2019. Following the inspection, the practice was rated requires improvement overall (inadequate in safe, requires improvement in effective and well-led, and good in caring and responsive). We issued a warning notice for breaches of Regulation 17 (Good Governance) and Regulation 12 (Safe care and treatment). This focused inspection was to follow up on the warning notices.

We did not review the ratings awarded to this practice at this 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 found the provider had made some improvements in providing safe services but further improvements were still needed. In particular the provider had removed some high-risk medicines from the formulary, but we still found examples of poor prescribing and relevant blood checks not being undertaken before issuing certain medicines. After the inspection the provider informed us that a further 355 medicines had been removed from the formulary.

We found that the provider had made some improvements for providing effective services. In particular the provider had added a functionality to their clinical system to enable a GP to tick a box when a patient gave consent for the service to share information with their NHS GP. However, we found examples of medicines liable to abuse being prescribed without gaining consent to share information with the patient’s NHS GP, which may have increased the risk of harm if the patient was getting the same medicine from their NHS GP.

We found the provider had made some improvements in providing well-led services in relation to good governance and had implemented systems and process in response to the findings of our previous inspection.

The practice will be re-inspected within six months of the original inspection report being published and this will be a full comprehensive inspection.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection areas

Safe

Inadequate

Updated 2 April 2020

At our previous inspection on 8 October 2019 we rated the provider as inadequate for

providing safe care and a warning notice was issued to the provider because:

  • There were examples of poor prescribing which included controlled drugs.
  • Consent to share information with the patients NHS GP was not always obtained before prescribing high risk medicines.
  • Patients were not always risk assessed appropriately.

We undertook this inspection to check that the concerns raised in the warning notice had been actioned.

Prescribing safety

The service had made some improvements to their systems for appropriate and safe handling of medicines but further improvements were still needed.

The provider had removed some high-risk medicines from their prescribing formulary such as Diazepam and Tramacet, but we still found an example of Lorazepam being prescribed in a large quantity. Since this inspection, the provider informed us that Lorazepam had been removed from the formulary.

The provider informed us that GPs had been communicated with and informed that all consultation notes must be thorough and clear. However, we still found examples of the GPs not fully completing the written notes.

Medicines were still being issued without the relevant blood checks being performed to ensure they were safe to prescribe. For example, a medicine used to treat acne was issued in a large quantity without ensuring the relevant blood tests had been carried out, and there was no discussion about contraception or the risks to pregnancy while taking the medicine which could cause birth defects. The provider did audit this consultation before the inspection and removed the medicine from the formulary after deciding it was inappropriate to prescribe.

After the inspection the provider informed us that they had removed a total of 355 medicines from their prescribing formulary which included high risk medicines such as sedatives.

High risk medicines were still prescribed without appropriate discussion of side effects. For example, a high risk non-steroidal anti-inflammatory drug (NSAID) was issued that carries cardiac risks. We reviewed the consultation and found there was no discussion with the patient about potential risks. After this inspection the provider informed us that this medicine had been removed from their prescribing formulary.

Effective

Requires improvement

Updated 2 April 2020

At our previous inspection on 8 October 2019 we rated the provider as requires improvement for

providing effective care and a warning notice was issued to the provider because:

  • Care and treatment was not always delivered in line with relevant guidance and standards.
  • We undertook this inspection to check that the concerns raised in the warning notice had been actioned.

Assessment and treatment

It was not always clear from consultation notes what had been discussed during the appointment. For example, we found an antibiotic being prescribed which was not safe to take during pregnancy. In the consultation notes it stated ‘not pregnant’, but there was no indication if contraception use had been discussed.

Coordinating patient care and information sharing

The provider had added a functionality to their clinical system to enable a GP to tick a box when a patient gave consent for the service to share information with their NHS GP. However, we found examples of medicines liable to abuse being prescribed without gaining consent to share with the patient’s NHS GP. For example, a hypnotic (a medicine to reduce anxiety or to aid sleep) was prescribed to a patient who had not given consent to share with their NHS GP.

Supporting patients to live healthier lives

We found an example of a patient being prescribed prophylactic (preventative) treatment for chlamydia without any discussion of sexual health or referral to a GUM clinic.

Caring

Good

Updated 2 April 2020

Responsive

Good

Updated 2 April 2020

Well-led

Requires improvement

Updated 2 April 2020

At our previous inspection on 8 October 2019 we rated the provider as requires improvement for

providing safe care and a warning notice was issued to the provider because:

  • Patient safety and MHRA alerts were not dealt with effectively.
  • Clinical meetings were not happening with GPs working at the service.
  • There was a lack of clinical oversight within the service.
  • Clinicians did not routinely record past medical history and drug history or allergies.

Governance arrangements

The service now had a system in place to deal with medicine and patient safety alerts. A staff member had been appointed responsible for checking the central alerting system daily and circulating the information to the service manager and pharmacist. A safety alert log was in place for all alerts that affected the service and any actions taken were recorded.

We saw evidence that a regular telephone conference call had been set up to allow GPs working at the service to dial into to discuss any clinical issues. Regular news bulletins were also sent out to clinical staff to keep them informed of any updates and changes.

A GP was working at the service one day a week as the clinical lead. We were informed that a contract to increase to two days a week had been agreed and due to commence on the 16 March 2020. The GP clinical lead had oversight of consultations and carried out audits at the service. We saw examples of medicines being removed from the formulary in response to prescribing audits.

The provider had added a functionality to their clinical system to enable a GP to tick a box when a patient’s medical history and allergies had been checked and updated. This information was displayed on the main page of the patient profile so it was clearly visible for the GP to view.