Archived: Nestor Primecare Services Ltd t/a Primecare - East Kent

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Nestor Primecare Services Ltd t/a Primecare - East Kent on 9, 10 and 11 May 2017. Overall the provider was rated as inadequate. The full comprehensive report on the 9, 10 and 11 May 2017 inspection can be found by selecting the ‘all reports’ link for Nestor Primecare Services Ltd t/a Primecare - East Kent on our website at www.cqc.org.uk. As a result of that inspection the service was placed in special measures. Additionally we served Warning Notices under The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulations 12, 17 and 18;:

• Safe care and treatment 12.—(1) Care and treatment must be provided in a safe way for service users.

• Good governance 17.—(1) Systems or processes must be established and operated effectively

• Staffing 18.—(1) Sufficient numbers of suitably qualified, competent, skilled and experienced persons must be deployed

We undertook this announced focused inspection on 27 September, to check that the provider had followed their action plan for the warning notices and to confirm that they now met the legal requirements. The provider was not rated as a consequence of this inspection, as they are in special measures. It will be inspected again, with a view to assessing the practice’s rating when the timescale for being placed into special measures has passed.

Our key findings were as follows:

• The system for reporting significant events had improved. Any staff member could raise a significant event. Investigation of events was more thorough

• There had been some improvement to the management of medicines

• Data showed the provider was not meeting the National Quality Requirements, particularly for face to face consultations.

• Data showed the provider was not meeting the National Minimum Data set requirements, particularly for telephone answering times.

• Compliance with mandatory training had improved

• Complaints were managed to a high standard

• The service had addressed many of the leadership and governance issues, with the introduction of improved systems. But evidence of the effectiveness of the new systems was weak.

  There remain areas where the provider must make improvements.

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

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

• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

Following the inspection we took enforcement action against the provider namely the service of two warning notices:

• Safe care and treatment 12.—(1) Care and treatment must be provided in a safe way for service users.

• Staffing 18.—(1) Sufficient numbers of suitably qualified, competent, skilled and experienced persons must be deployed.

The provider remains in special measures. Services placed in special measures will be inspected again within six months of the date of the publication of the initial comprehensive inspection. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we may take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This may 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 Nestor Primecare Services Ltd t/a Primecare - East Kent on 9,10 and 11 May 2017. Overall the service is rated as inadequate.

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

• Not all staff were clear about reporting incidents, near misses and concerns. Although the service carried out investigations when there were unintended or unexpected safety incidents the investigations were superficial. There was some evidence of lessons learned but they were not communicated systematically to all staff.
• There were some arrangements for identifying, recording and managing risks, issues and implementing mitigating actions. However the arrangements had failed to recognise and address some risks.
• Patients’ care needs were not always assessed and delivered in a timely way. The provider failed to meet some key National Quality Requirements.
• There was little monitoring of whether staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff training was not comprehensive.
• Some staff reported that they could not access patients’ records.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. However there were long delays in dealing with complaints. Analysis of the root cause of complaints was superficial. There was limited evidence of learning from complaints.
• The service worked with other organisations and providers to develop services that supported alternatives to hospital admission where appropriate.
• The service had good facilities and was well equipped to treat patients and meet their needs. The vehicles used for home visits were clean and well equipped.
• The leadership structure was not clear to staff and some staff did not feel supported by management.
• The provider had not sought feedback from staff. There were no regular staff meetings. Feedback from patients was very limited.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• In the clinical and managerial governance arrangements
• In the recording of complaints
• In the deployment of suitably qualified, competent, skilled and experienced staff
• In the provision of safe care and treatment

Following the inspection we took enforcement action against the provider namely the service of three warning notices:

• Safe care and treatment 12.—(1) Care and treatment must be provided in a safe way for service users.
• Good governance 17.—(1) Systems or processes must be established and operated effectively
• Staffing 18.—(1) Sufficient numbers of suitably qualified, competent, skilled and experienced persons must be deployed.

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 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 FRCGPChief Inspector of General Practice