The Care Quality Commission
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Archived: Kirkby Community Primary Care Centre Also known as Central Nottinghamshire Clinical Services

Overall: Inadequate read more about inspection ratings

Ashfield Health Village, Portland Street, Kirkby in Ashfield, Nottinghamshire, NG17 7AE (01623) 434600

Provided and run by:
Central Nottinghamshire Clinical Services Limited

All Inspections

30/09/2015

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an unannounced focused inspection at Kirkby Community Primary Care Centre on 30 September 2015. The inspection was to follow up warning notices we issued after an inspection on 13 May 2015 from which overall services provided at the practice were rated inadequate and the location was placed into special measures.

We found the provider to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The regulations breached were:

Regulation 12: Safe care and treatment

Regulation 17: Good governance

As this was a follow up inspection we looked at the areas we identified in the warning notice which were about safe care and treatment to see if the improvements had been made. During the inspection we saw other areas of serious concern.

Our key findings were as follows:

  • The provider had made improvements to the calibration and safety testing of equipment.
  • Care plans for patients who were at risk of unplanned admission to hospital had been implemented.
  • A new system of recording incidents, near misses and concerns had been implemented although it was too early to assess the effectiveness.
  • We saw patients had not received essential medicines they needed to treat their condition.
  • Children had been put at risk of unsafe care due to the provider’s poor and increasingly worsening performance in administering childhood vaccinations.
  • A number of patients had received medicines without any monitoring of their health or in line with their treatment plan.
  • The poor governance of record management and lack of oversight for safeguarding children could put them at increased risk of harm.
  • There were historic and widespread errors with the accuracy of clinically coding health records which had led to missed opportunities for health screening and safe treatment of patients.

In relation to all of the areas of concern identified, the provider (Central Nottinghamshire Clinical Services) and NHS commissioning organisations were informed to ensure any of the risks identified during our inspection were investigated. We also informed the local authority safeguarding team of our findings.

Following our inspection, due to the serious concerns identified we urgently varied the conditions of provider’s registration with the Care Quality Commission (CQC) and stopped the provider providing GP services at Kirkby Community Primary Care Centre on 2 October 2015.

If the provider was still able to provide GP services at Kirkby Community Primary Care Centre we would have told them they must have made the following improvements:

  • The process for providing care and treatment to patients must be carried out in a safe way and to nationally recognised standards.
  • Review care records and assess the risks to the health and safety of patients who use the practice.
  • Ensure that any incidents that affect, or have affected, the safe care and treatment are recorded, investigated and learnt from.
  • Where incidents that have caused harm are identified. Those affected must be told in line with duty of candour.
  • Ensure the prescribing, and oversight, of medicines is safe and effective.
  • Ensure that medicines are stored in line with manufacturer’s instructions.

As part of our action we liaised with NHS England and NHS Mansfield and Ashfield Clinical Commissioning Group. This ensured that patients had continued access to GP services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

13/05/2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kirkby Community Primary Care Centre on 13 May 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice to be inadequate for providing safe, effective, responsive and well-led services and requiring improvement for caring services. The concerns which led to these ratings apply to everyone using the practice including the population groups of for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia. All of the population groups have been rated as inadequate.

Our key findings were as follows:

  • Data showed outcomes for some patients were significantly below average for the locality. Although some audits had been carried out, they had not been completed and we saw no evidence that audits were driving improvement in performance in respect of patient outcomes.
  • Patients said they were treated with compassion, dignity and respect, although some patients expressed concern about the lack of continuity in their care.
  • Patients had mixed views about appointments. Most told us that non-urgent appointments were usually available. However, some patients told us it could be difficult to get an urgent appointment.
  • The number of patients visiting a local 24 hour walk in centre was 95% higher than the local average. We also saw that the number of patients attending accident and emergency department was 24% higher than the local average. The practice was aware of this, although had not investigated the reasons.
  • The practice had not been handling complaints in line with national guidance and there was no evidence that learning from complaints was being shared with practice staff to improve the service being delivered.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure that the recording, investigation and dissemination of learning from significant events is robust.
  • Ensure that assessment and care that is offered to patients is recorded and reflects recognised national guidance.
  • Provide all staff at the practice with appraisals and the regular opportunity to explore individual training needs relevant to their role.
  • Improve the handling, recording and dissemination of learning from complaints received to enable lessons to be learned and secure service improvements.
  • Actively seek the views of patients and those acting on their behalf about how the care and treatment provided meets their needs and use this to assess and monitor the quality of the service.
  • Ensure that all equipment used in the practice has been tested to ensure it is safe and fit for purpose.

In addition the provider should:

  • Improve security for the issuing and tracking of blank prescription forms to reflect nationally accepted guidance as detailed in NHS Protect.
  • Specify the levels of training required for locum GPs in the service level agreement with recruitment agencies.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice