The Care Quality Commission
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  • GP practice

Archived: The Mandeville Practice

Overall: Inadequate read more about inspection ratings

Hannon Road, Aylesbury, Buckinghamshire, HP21 8TR 0844 387 8383

Provided and run by:
The Practice U Surgeries Limited

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

All Inspections

10 January 2018

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Inadequate overall.

We carried out a comprehensive inspection of The Mandeville Practice in April 2017, the practice had an overall rating of Inadequate. Specifically, the practice was rated as requires improvement for safe, caring and responsive services and inadequate for effective and well led services. We undertook a focused inspection in August 2017 to follow up on warning notices that had been issued following the April 2017 inspection.

Following the January 2018 inspection the key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Inadequate

Are services well-led? - Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

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

We carried out an announced comprehensive inspection at The Mandeville Practice on 10 January 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether The Mandeville Practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

  • The practice did not have clear systems to identify and manage risk. For example, known high risk actions from a fire risk assessment had not been acted upon and other risk assessments had not been considered or documented. In addition, staff recruitment processes had not considered the risks associated with staff commencing employment before their background checks had been received.
  • There were duplicate safeguarding policies available, which may be confusing to staff and we found gaps in staff safeguarding training.
  • Patient outcomes data collected via the quality and outcomes framework demonstrated improvements in care for some patient groups although many remained below local and national averages.
  • The practice had not considered or responded to the needs of its elderly patients in a local care home.
  • Staff treated patients with dignity and respect.
  • The practice had recently changed the telephone system and all calls were now handled at the practice. It was too soon to gauge the impact this had on patients.
  • Governance processes and systems were not effective and had failed to identify a lack of staff training, risk assessments and patient care relating to dementia.

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

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
  • Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.

The areas where the provider should make improvements are:

  • Review complaints response documentation to include details of the health ombudsman as in line with your provider policy.

This service was placed in special measures in June 2017. Although this report identifies where improvements and changes to practice have been made, insufficient improvements have been made overall. The practice is rated as inadequate for providing safe, effective, responsive and well-led services and good for caring services. As a result, I am keeping the practice in special measures and we have taken action in line with our enforcement procedures. At the time of this inspection we were aware of a planned change in provider contract in April 2018. 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

23 August 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced inspection of The Mandeville Practice on 23 August 2017. This was to follow up on a warning notice the Care Quality Commission served following an announced comprehensive inspection on 5 April 2017 when the practice was rated as inadequate for providing well led services.

The warning notice was served relating to regulation 17: Good Governance of the Health and Social Care Act 2008. The timescale given to meet the requirements of the warning notice was 1 August 2017.

The April 2017 inspection highlighted several areas where the provider had not met the standards of regulation 17: Good governance. We found:

  • Failure to ensure the provider assessed, monitored and improved the quality and safety of the services provided and mitigate the risks relating to the health, safety and welfare of patients and others who may be at risk.
  • The provider did not ensure records for the care and treatment provided to patients were kept securely.
  • A failure to seek and act on feedback for the purpose of continually evaluating and improving the services.

At this inspection in August 2017 we found that actions had been taken to improve the provision of well led services. Specifically the practice had:

  • Reviewed the governance arrangements for all areas of practice outlined in the warning notice.
  • Introduced a new system for the monitoring of training, although this was not fully implemented at the time of inspection.
  • Reviewed the emergency medicine and equipment arrangements to ensure ease of access when needed quickly. However, an emergency medicine to treat an opioid (a strong pain-killer) overdose was not available and the provider had not assessed this risk.
  • Improved the arrangements for recording ongoing recruitment and governing body checks.
  • Introduced regular staff and clinical meetings to ensure learning from significant events and complaints was monitored and communicated with the team.
  • Installed a ‘you said we did’ board to show actions following patient feedback.
  • Completed or commenced staff appraisals for all staff that had been in post for over 12 months.
  • Undertaken further clinical audits and demonstrated improvements to patient care and outcomes.

The areas where the provider should make improvements are:

  • Ensure training for all staff is monitored by the provider.
  • Ensure the stock of emergency medicines is reviewed and risk assessed.

At our previous inspection in April 2017, we rated the practice as inadequate for the provision of well-led services and gave the practice an overall rating of inadequate. At this inspection we have focused on the warning notice findings in respect of the well led section of our report. We found that the practice had taken action to address the breaches of regulation set out in the warning notice issued in June 2016. However, the current ratings will remain until the practice receives a further comprehensive inspection to assess the improvements achieved against all breaches of regulation identified at the previous inspections.

The comprehensive report published on 29 June 2017 should be read in conjunction with this report.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

5 April 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Mandeville Practice on 5 April 2017. Overall the practice is rated as inadequate.

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

  • Over the previous two years the practice had gone through significant changes including a new provider and changes of key members of staff, such as some of the GPs and the practice manager.
  • The Mandeville practice had a new leadership structure. Staff told us the management and leadership team were approachable and always took the time to listen to all members of staff. However, the findings during the inspection were that the communication between the provider and the practice leadership could be improved.
  • The delivery of high quality care was not assured by the leadership, governance or culture in the practice. Systems to monitor and make quality improvements were limited.
  • Patients were at risk as they were not always given appropriate support, care and treatment to manage their long term conditions.
  • 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 of identifying learning and communicating this with staff.
  • Risks to patients were assessed and managed, with the exception of those relating to the access of emergency medicines and the storage and security of prescription stationery.
  • Staff were aware of current evidence based guidance. Staff training records were held centrally by the provider human resources team.
  • The practice had a number of policies and procedures to govern activity. This was supported centrally by human resources checking processes and records.
  • Information about services and how to complain was available.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
  • Data showed some patient outcomes were significantly low compared to the national average. Although some audits had been carried out, we saw no evidence that audits were driving improvements to patient outcomes.

The areas where the provider must make improvements are:

  • Ensure they assess, monitor and improve the quality and safety of the services provided and mitigate the risks relating to the health, safety and welfare of patients and others who may be at risk.
  • Ensure records for the care and treatment provided to patients are kept securely.
  • Seek and act on feedback for the purpose of continually evaluating and improving the services.

The areas where the provider should make improvements are

  • Continue to encourage patients to engage with national cancer screening programmes.

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 practice 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