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Inspection carried out on 04/04/2019

During a routine inspection

We carried out an announced comprehensive inspection at Park Grange Medical Centre on 4 April 2019 as part of our inspection programme. Park Grange Medical Centre was previously inspected on 2 May 2018 and was rated as good.

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 have rated this practice as good overall.

We found that:

  • The practice provided care in an organised and effective manner that kept patients safe and protected them from avoidable harm.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care. Data taken from the NHS website showed that 90% of patients would recommend the practice to their family and friends. Patients could access care and treatment in a timely way.
  • The practice planned, organised, delivered and reviewed services to meet patients’ needs. There were clear responsibilities, roles and systems of accountability to support good governance and management.

We saw areas of outstanding practice:

  • We found that the continued use of innovative templates and the manipulation of the IT systems at the practice ensured that patients received safe and effective care. For example, the practice had responded to a Medicines and Healthcare Products Regulatory Agency (MHRA) alert for a specific medicine. If the clinician looked to prescribe the medicine, the template would alert the clinician, link to the alert and also link to the relevant patient information leaflet. A number of templates which had been developed at our last inspection had been updated in line with guidelines and shared with the staff team. The safe and innovative systems automatically pre-populated patient information, prompted clinicians to consider additional aspects of the person’s care and ensured that patient needs were met.
  • A general practice matrix was in place to ensure that all environmental and building maintenance checks were up to date and could be easily monitored. The matrix turned amber when checks were due. This comprehensive, detailed list of security measures included an ongoing review of fire, evacuation, infection prevention, risk assessments and contracts. We saw that all issues relating to the day to day management of a general practice had been considered and were being monitored closely.

Whilst we found no breaches of regulations, the provider should:

  • Continue to improve and encourage the uptake of cancer screening by patients registered with the practice, including cervical, breast and bowel cancer screening.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care


Inspection carried out on 2 & 3 May 2018

During a routine inspection

This practice is rated as good overall.

(Previous inspection 5 and 8 September 2017- Inadequate.)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Park Grange Medical Centre on 5 and 8 September 2017. The overall rating for the practice at that time was Inadequate. The full comprehensive report on the September 2017 inspection can be found by selecting the ‘all reports’ link for Park Grange Medical Centre on our website at www.cqc.org.uk. 

Following the inspection on 5 and 8 September 2017, we applied an urgent condition to the providers’ registration. The provider was told they must not use the recently constructed extension to the practice without the prior written agreement of CQC, which would only be given after they had provided adequate proof that the extension met Regulation 12 (1) (2) (d) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The actions taken by the provider were reviewed in detail during an inspection on 7 March 2018 and a separate report was produced. The provider was able to evidence compliance with the condition imposed on their registration and the condition was removed.

This inspection was an announced comprehensive inspection carried out on 2 and 3 May 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 5 and 8 September 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

At this inspection we found:

  • The practice had implemented clear systems and processes to manage risk so that safety incidents were less likely to happen. We saw evidence that when incidents did happen, the practice reviewed these as a team, learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided and used technology to support this. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • There were up to date, comprehensive risk assessments in relation to safety issues.
  • The practice had completed all the works required relating to the extension of the practice. A certificate evidenced that works had been completed to the required standards.
  • Patients told us they were treated with compassion, kindness, dignity and respect.
  • Results of the July 2017 GP patient survey data showed patients did not always find the appointment system easy to use. However, feedback from patients and data collected by the practice since this time did not align with this view.
  • There was a strong focus on management oversight, innovation, improvement and continuous learning and at all levels of the organisation.
  • A clinical and non-clinical lead had been appointed to manage infection prevention and control (IPC). Staff were up to date with IPC training, an audit had been completed and an action plan was in place. Cleaning schedules had been implemented for clinical equipment and clinic rooms.
  • The practice was able to describe how it had developed its cultural competence to address the needs of its diverse population. For example, ensuring timely completion of documentation following a patient death to facilitate religious burial timeframes, and the proactive review of medicines and advice during periods of fasting.

We saw one area of outstanding practice:

  • One of the GP partners was interested in how technology could assist to improve and deliver safe and effective patient care. A number of templates, safety nets and processes had been developed within the computer systems; which allowed clinicians to complete referrals letters, prescribe safely and carry out thorough and comprehensive reviews to a high standard directly from the patient record. The safe and innovative system automatically pre-populated patient information, reducing human error, time and delays.

The areas where the provider should make improvements are:

  • The provider should continue to review and take steps to improve the uptake of screening at the practice, including breast, bowel and cervical screening.
  • The provider should continue to review and respond to the results of patient satisfaction surveys and ensure that they can meet the needs of their patient population in the future.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service. These improvements now need to be sustained, moving forwards.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection carried out on 07 March 2018

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

We carried out an announced comprehensive inspection at Park Grange Medical Centre on 5 September 2017. The overall rating for the practice was inadequate. The full comprehensive report on the September 2017 inspection can be found by selecting the ‘all reports’ link for Park Grange Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection, carried out on 7 March 2018 at the request of the practice. The purpose of this inspection was to review actions taken by the provider in response to the comprehensive inspection that took place on 5 September 2017. During the September 2017 inspection an urgent notice of decision was issued by the Care Quality Commission under section 31 of the Health and Social care Act 2008.This decision imposed a condition on the registration of the provider relating to the use of a newly built extension at the location.

During the inspection on 5 September 2017, (and consequently in writing) the provider, Park Grange Medical Centre, were informed that they should cease use of the newly constructed extension until evidence was provided that the extension met Regulation 12 (1) of the Health and Social care Act 2008.

This report covers our findings in relation to this imposed condition only.

Our key findings were as follows:

  • The provider had complied with the condition imposed by the Care Quality Commission and the extension was not in use.
  • The provider had taken steps to ensure the safety of the patients’ using their building and had produced detailed action plans, which they had acted upon.
  • The provider had taken the action required to address the serious concerns we identified at the inspection on 5 September 2017. As a result we will be issuing a Notice of Proposal to remove the urgent condition we applied to the provider’s registration to prevent them from using the recently constructed extension to the premises.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 5th & 8th September 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Grange Medical Centre on 5th & 8th of September 2017. Overall the practice is rated as inadequate. The practice is rated as inadequate for providing safe and well led services. They are also rated as requires improvement for providing effective services and good for providing caring and responsive services.

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

  • There was a partial governance framework in place to support the delivery of the strategy and good quality care. However, we saw that the provider had failed to assess, monitor and mitigate serious risks relating to the health, safety and welfare of service users and others who used the premises. We also saw that fire and building risk assessments were not up to date.

  • Several members of staff did not have a written contract of employment, had not received a written induction plan, mandatory training or documented supervision or an appraisal of their performance since the commencement of their employment.

  • Some risks to patients were assessed and well managed. For example, the monitoring of patients taking high risk medicines and those on long term medication were supported by an innovative recall system developed the provider.

  • There were a number of policies and procedures to govern activity. However, some policies were in need of clarification and review. The provider did not maintain a complete register of staff training.

  • The provider had a system for reporting and analysing significant events. The events recorded were relatively few in number. However, they had been appropriately reviewed and the learning shared.

  • Staff were aware of and worked to implement current evidence based guidance.
  • Patients we spoke with on the day said they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

  • Data from the national GP patient survey showed the majority of patients found the provider caring. However, the practice was rated lower than others both locally and nationally for most aspects of care. The provider had reviewed these results and had made a detailed action plan to address the areas identified.

  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice was well equipped to treat patients and meet their needs.
  • The practice had clear aspirations and a strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • We saw evidence that audits were driving improvements to patient outcomes.
  • There was a clear leadership structure and staff felt supported by management. The practice had a patient participation group which met regularly.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
  • Regular clinical meetings were held and documented.

Following our inspection, due to the serious concerns identified we urgently varied the conditions of provider’s registration with the Care Quality Commission (CQC) under section 31 of the Health and Social Care Act 2008. We told the provider they must not use the recently constructed extension to the practice without the prior written agreement of CQC. The provider was allowed 28 days to make an appeal against this decision; they chose not to do so.

The areas where the provider must make improvements are:

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

  • The provider must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

In addition the provider should:

  • Review the provision of documented cleaning schedules for the building and clinical equipment to be assured that appropriate levels of hygiene are maintained.
  • Review progress in improving patient access following the results of the national GP patient survey.

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