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Archived: Fernbank Medical Practice Inadequate

The provider of this service changed - see new profile

We are carrying out a review of quality at Fernbank Medical Practice. We will publish a report when our review is complete. Find out more about our inspection reports.


Inspection carried out on 14 March 2018

During an inspection to make sure that the improvements required had been made

We carried out an announced focused inspection on 14 March 2018. This inspection was undertaken to follow up on breaches in regulations that we identified. We issued a Warning Notice to the provider in relation to:

  • Regulation 12: Safe care and treatment, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider was required to be compliant against the requirements of the Warning Notice by 7 February 2018.

The provider received an overall rating of inadequate following our inspection on 7 November 2017 and was placed into special measures. This will remain unchanged until we undertake a further full comprehensive inspection within six months of the publication date of the report. The full comprehensive report on the November 2017 inspection can be found by selecting the ‘all reports’ link for Fernbank Medical Practice on our website at

This report only covers our findings in relation to the areas identified in the Warning Notice as inadequate during our inspection in November 2017.

Our key findings were as follows:

  • We found the provider was making progress towards meeting the full legal requirements in relation to the breaches in regulations that we identified as part of our warning notice.

  • The provider advised us that non-clinical staff had ceased carrying out duties which were typically carried out by clinical staff. To support this action, the provider had increased clinical staffing to include a locum GP, a locum practice nurse and locum health care assistant. However, evidence of qualifications and training was not consistently available for all roles undertaken by locum staff.

  • A system had been established for managing safety alerts received. We reviewed several examples, which showed clear evidence of action taken and shared learning. However, in one instance the provider had not considered action where third party prescribing had taken place.

  • The provider had reviewed and updated their policy for incident reporting but advised us that there had been no new incidents reported since our previous inspection in November 2017. We were therefore unable to assess the level of progress made in this area.

  • We saw evidence of progress made in working with external services to support care and treatment. Since our previous inspection multi-disciplinary team meetings had been held with members of the palliative care and community teams and with the mental health teams to discuss some of the practices most vulnerable patients.

The practice had implemented an action plan to address the areas identified in the warning notice. It was evident that action had been taken to address and improve patient outcomes. However, some of the required actions were not yet fully completed or embedded and will be reviewed again at the next inspection. As a result, the areas where the provider must continue to make improvement are:

  • Ensure all incidents that affect the health, safety and welfare of people using the service are reviewed, thoroughly investigated and monitored to make sure that action was taken to remedy the situation, prevent further occurrence and make sure that improvements are made as a result.

  • Ensure effective systems are in place to check that staff work within the scope of their qualifications, competence, skills and experience.

The areas where the provider should make improvement are:

  • Consider all patients affected by safety alerts, including where third sector prescribing has occurred, to ensure patients are made aware of any issues either directly or through the third sector prescriber.

  • Consider developing standard criteria for staff undertaking health checks to escalate

This service was placed in special measures in November 2017 and is due to be inspected again within six months of the publication of the final report. When we re-inspect, we will also look at whether further progress has been made to enable compliance with Regulation 12: safe care and treatment HSCA (RA) Regulations 2014; including specific areas for improvement such as management of incidents and effective staffing.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 7 November 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice was first inspected on 17 November 2016 under the previous provider and was rated as requires improvement for providing safe, caring, responsive and well-led services, and found to be inadequate for providing effective services. As a result of our findings during the November 2016 inspection, we asked the practice to provide a report that says what actions they were going to take to meet legal requirements. Since our November 2016 inspection, the practice changed their registration from a two GP partnership to a single handed GP provider.

This practice was inspected on 7 November 2017 under the new registration and rated as inadequate overall.

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. 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 recently 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 Fernbank Medical Practice on 7 November 2017 as part of our inspection programme.

At this inspection we found:

Staff operated systems and processes to support the delivery of services to the local community; however, there were areas where processes were not effective enough to keep people safe. Systems for monitoring training needs were not operated effectively; there was limited participation in multidisciplinary working and the practice did not analyse national surveys or establish plans to improve patient satisfaction. The approach to service delivery, improvements and risk management were reactive and only focused on short-term issues. Clarity amongst the management team regarding their responsibilities was limited and the management team was not always working cohesively.

  • The practice had systems to manage risk so that safety incidents were less likely to happen; however, staff members did not consistently follow the system. For example, when incidents happened, the practice were unable to demonstrate that they consistently learned from them and improved processes as a result.

  • Safety alerts were not acted on to ensure compliance and corrective actions identified in some risk assessments had not been completed.

  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was mainly delivered according to evidence- based guidelines. However, the practice did not ensure staff received appropriate training in some areas to cover the scope of their work.

  • There were systems in place to monitor and ensure the use of medicines prescribed such as antibiotics remained effective and in line with national guidelines.

  • Staff demonstrated how they involved and treated patients with compassion, kindness, dignity and respect. However, results from the July 2017 annual national GP survey showed patient satisfaction was below local and national averages in a number of areas. The practice was aware of these results; however, had not analysed the results or established a plan to improve patient satisfaction.

  • Patients found the appointment system easy to use; however, some completed Care Quality Commission (CQC) comment cards and national GP survey results showed that patients were not always able to access care when they needed it.

  • The practice operated effective systems for identifying carers and staff were actively involved in ensuring carers received support.

  • Complaints were well managed, taken seriously and responded to in a timely way.

  • Leadership, management and governance arrangements did not always support the delivery of high-quality and effective care. For example, oversight of systems and processes did not provide assurance that identified risks and areas of poor performance were being sufficiently responded to. There were some evidence of shared learning; however, improvements were not always identified and evidence of actions taken were limited.

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

  • Ensure persons employed in the provision of the regulated activity receive the appropriate training necessary to enable them to carry out the duties.

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

The areas where the provider should make improvements are:

  • Continue to encourage patients to attend national screening programmes and ensure clear access to cervical screening is established.

  • Establish processes for sharing information with community teams to ensure care plans and medication reviews are carried out with patients in receipt of interventions for substance and alcohol dependency and recorded on the clinical syatem.

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