23/04/2018
During an inspection looking at part of the service
We carried out an announced comprehensive inspection at RJ Mitchell Medical Centre on 6 February 2018. The overall rating for the practice was requires improvement with requires improvement in well led and inadequate in safe. Breaches of legal requirements were found and a warning notice was served in relation to good governance and requirement notices in relation to safe care and treatment and fit and proper persons employed. The full comprehensive report on the February 2018 inspection can be found by selecting the ‘all reports’ link for RJ Mitchell Medical Centre on our website at www.cqc.org.uk.
This inspection was an announced comprehensive inspection carried out on 23 April 2018 to confirm that the practice met the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 6 February 2018. We found serious concerns about patient safety, therefore we went back to complete the inspection on 27 and 30 April 2018. We told the practice to submit an action plan by 8 May 2018 to detail how the serious concerns that put patients at risk had been/would be addressed. An action plan was submitted and the provider submitted an application to cancel their registration with the Care Quality Commission. Should they have remained registered we would have taken greater enforcement action.
Our key findings were as follows:
- Staff that checked the temperature of the vaccine fridge were aware of the correct temperature range for vaccine storage. The practice’s cold chain policy had been updated to include guidance on ensuring the cold chain was maintained when transporting flu vaccines to local care homes.
- Emergency medicines had been reviewed and suggested emergency medicines were held in a central location at the main practice. A formal system to check that the emergency medicines were in date had been implemented.
- A risk assessment had been completed to demonstrate how risks to patients would be mitigated in the absence of recommended emergency medicines taken on GP home visits.
- A system to track the use of prescriptions used in printers throughout the practice had been implemented.
- Legionella risk assessments had been completed and an action plan put in place to mitigate risks identified. Staff had been referred for assessment of staff immunity against health care acquired infections. Risk assessments had been completed where immunity was not present.
- Access arrangements for disabled patients through the entrance doors of the practices had been reviewed.
- Patients told us they were treated with dignity and respect and there was easy access to appointments.
- Systems to safeguard vulnerable adults and children from the risk of abuse were not effective.
- An effective system to ensure the monitoring of patients on high risk medicines was not in place.
- Systems to monitor the collection of repeat prescriptions were not effective.
- Systems for the prescribing of controlled medicines were not effective and did not keep patients safe.
- A clear process in regard to the receipt, analysis and response to Medicines and Healthcare products Regulatory Agency (MHRA) was not in place.
- Patients with infections did not always receive recommended treatment or investigations.
- Staff recruitment checks did not meet legal requirements. There was no formal system in place to monitor that professional registrations were in date. Medical indemnity cover for clinical staff had been put in place.
- Patients with a learning disability had been offered a review of their health however care plans had not been put in place. Care plans were not in place for patients receiving end of life care or patients experiencing poor mental health.
- Patient referral letters to other services, completed by administrative staff, contained inadequate medical histories and examination findings and were not signed or checked by a GP before being sent.
- There were systems for reviewing and investigating when things went wrong however the learning identified was not always applied to practice.
- A clearly defined strategy to deliver the practice’s vision had not been put in place.
There were areas of practice where the provider needs to make improvements.
Importantly, the provider must:
- Ensure care and treatment is provided in a safe way to patients.
- Ensure specified information is available regarding each person employed.
- Ensure, where appropriate, persons employed are registered with the relevant professional body.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
In addition the provider should:
- Develop a clearly defined strategy to deliver the practice’s vision.
We found several risks we identified at our previous inspection had not been effectively mitigated. In particular:
- Incomplete recruitment checks.
- A system to monitor professional registrations were in date had not been implemented.
- An effective system to ensure the monitoring of patients on high risk medicines was not in place.
- Systems to monitor the collection of repeat prescriptions were not effective.
- A clear process in regard to the receipt, analysis and response to Medicines and Healthcare products Regulatory Agency (MHRA) was not in place.
- A clearly defined strategy to deliver the practice’s vision was not in place.
For further information, please refer to the evidence table that accompanies this report.
At our previous inspection we rated the practice as inadequate in delivering safe services. At this inspection we found the service had failed to make sufficient improvement, and remains rated as inadequate for delivering safe services. The practice is also rated inadequate in well led and inadequate overall.
I am placing this service into 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.
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