Archived: Keyhealth Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Keyhealth Medical Centre on 22nd August 2017. Overall the practice is rated as inadequate.

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

• There was not a transparent approach to safety. The system for learning from and actioning significant events was not effective.
• Searches were not being routinely undertaken to identify patients who may be at risk as a result of Medicine and Healthcare products Regulatory Agency (MHRA) alerts.
• There were not adequate systems in place to manage and respond to pathology results.
• Not all staff were trained in adult or child safeguarding. The safeguarding vulnerable adults’ policy did not identify a lead member of staff.
• The practice manager had experience of dealing with patients who had experienced issues with drug and alcohol misuse and utilised skills to involve patients in their care.
• Not all chaperones were trained, DBS checked or risk assessed as to their suitability to the role.
• The practice maintained appropriate standards of cleanliness and hygiene, although actions identified in the infection control audit had not been completed.
• Recruitment checks were not consistently applied.
• The system in place to ensure that clinical staff were following NICE guidance was not effective.
• The practice did not monitor the use of prescription stationery around the practice, although prescription stationery was stored securely.
• Staff had not received training in health and safety, infection control or basic life support.
• Staff did not have the skills and knowledge to support the delivery of effective care.
• There were not effective systems in place to share information with other providers.
• Patient feedback was variable about the care received at the practice. National GP patient survey results published in July 2017 showed that the practice was performing in line with CCG and national averages in respect of consultations with the nurse, and in line with or below CCG and national averages in respect of consultations with the GPs.
• There were no processes in place to support carers. 0.9% of patients who were carers had been identified.
• There were 20 patients on the learning disabilities register and two had received a health check in the last year.
• The practice did not monitor inadequate cervical smear rates. The nurse was not aware of any failsafe procedures which sought to ensure an effective sample was taken.
• Patients said there was a lack of consistency and presence of GPs and that they experienced difficulties obtaining appointments.
• Information about how to complain was not easily available to patients.
• The practice team was not strong. There was a lack of presence and leadership by the lead GP and the administration workforce as a whole were not settled or embedded into their roles. Clinical staff were transient: nurses were self-employed and all GPs, aside from the lead GP, were locums.

The areas where the provider must make improvement are:

• Ensure effective systems and processes are established in relation to good governance in accordance with the regulations and fundamental standards of care.
• 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 support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
• Ensure the issues highlighted in the national GP patient survey are addressed in order to improve patient satisfaction, including concerns relating to appointment access and consultations with GPs.

The areas where the provider should make improvement are:

• Complete actions identified as required in the infection control audit.
• Update the safeguarding adults’ policy to identify the lead clinician responsible for safeguarding.
• Improve the identification of carers in order to provide them with appropriate support.
• Make available information about how to make a complaint, the availability of chaperones and the changes to the provider.

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 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.

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