Archived: Dashwood Medical Centre

Updated 18 August 2023

Dashwood Medical Centre is located at 158-160 Grange Road, Ramsgate, Kent, CT11 9PR.

The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, treatment of disease, disorder or injury and family planning. The provider is in the process of registering for the Regulated Activity, Maternity and Midwifery Services.

The practice is situated within the Kent and Medway Integrated Care System (ICS) General Medical Services (GMS) to a patient population of approximately 10,000 patients. This is part of a contract held with NHS England.

The practice is part of a wider network of GP practices: Ramsgate Primary Care Network (PCN).

Information published by Office for Health Improvement and Disparities shows that deprivation within the practice population group is in the second lowest decile (2 of 10). The lower the decile, the more deprived the practice population is relative to others.

According to the latest available data, the ethnic make-up of the practice area is 95.2% White, 2.0% Asian, 1.9% Mixed, 0.7% Black, and 0.2% Other.

The age distribution of the practice population closely mirrors the local and national averages.

There is a team of 5 GPs at the practice. The practice has a team of 1 clinical pharmacist and 2 nurses who provide nurse led clinics for long-term conditions. The GPs are supported at the practice by a team of reception and administration staff. The practice manager provides managerial oversight.

The practice is open between 8am to 6pm Monday to Friday. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments.

Extended access is provided locally by the PCN, where late evening and weekend appointments are available. Out of hours services are provided by NHS 111. NHS 111 deals with urgent problems when GP surgeries are closed.

Updated 18 August 2023

We carried out an announced comprehensive inspection at Dashwood Medical Centre on 23 November 2022. Overall, the practice is rated as inadequate.

Safe - inadequate.

Effective – requires improvement

Caring – good.

Responsive - requires improvement.

Well-led – inadequate.

Following our previous inspection on 9 May 2017 the practice was rated requires improvement overall and for delivering safe, effective, responsive and well-led services, but rated good for providing caring services. At a follow up inspection on 8 November 2017 the practice was rated as good overall and in all domains.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dashwood Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.

Our findings

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 rated the practice as Inadequate for providing safe services because:

• The practice did not have clear systems, practices and processes to keep people safe and safeguarded from abuse.
• Appropriate standards of cleanliness and hygiene were not always met.
• There were gaps in systems to assess, monitor and manage risks to patient safety.
• Staff had some information they needed to deliver safe care and treatment. However, improvements were required.
• The practice had systems for the appropriate and safe use of medicines, including medicines optimisation. However, improvements were needed.
• The practice did not have a robust system to learn and make improvements when things went wrong.

We rated the practice as Requires Improvement for providing effective services because:

• Patients’ needs were not always assessed, and care and treatment were not always delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
• The practice was unable to demonstrate that all staff had the skills, knowledge and experience to carry out their roles.
• The practice always obtained consent to care and treatment. However, DNACPR decisions were not always made in line with legislation and guidance.

We rated the practice as Requires Improvement for providing responsive services because:

• Complaints were not used to improve the quality of care.

We rated the practice as Inadequate for providing well-led services because:

• There was compassionate and inclusive leadership, however improvements were needed to ensure the delivery of high-quality sustainable care.
• The practice had a culture which drove high quality sustainable care. However, the provider was unable to demonstrate they had an effective complaints procedure.
• There were some responsibilities and roles to support good governance and management. However, improvements were needed to systems of accountability for the management of backlogs of activity.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• There was little evidence of systems and processes for learning, continuous improvement and innovation.

We found two breaches of regulations. The provider must:

• Ensure care and treatment is provided in a safe way for service users.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

• Continue to improve cervical cancer screening uptake.
• Continue to improve child immunisation uptake.
• Use feedback from staff and patients to improve national GP patient survey satisfaction scores.

I am placing this service into 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 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.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services