Background to this inspection
Updated
14 August 2018
Bilborough Medical Centre provides primary medical services to approximately 9250 patients in the Bilborough area of Nottingham. The practice is located at Bracebridge Drive, Bilborough Nottingham, Nottinghamshire, NG8 4PN. Services are also provided from a branch practice at Assarts Farm Medical Centre, 8 Upminster Drive, Nuthall, Nottingham, NG16 1PT.
The provider is registered for the provision of the following regulated activities from Bilborough Medical Centre:
• Diagnostic and screening procedures
• Family planning
• Maternity and midwifery services
• Surgical procedures
• Treatment of disease, disorder or injury
Services at Bilborough Medical Centre are provided by Bilborough Medical Partnership. Bilborough Medical Partnership registered with the CQC as the provider of this service on 18 December 2017. Although this was a new registration as a new partnership, the current partners had been operating under the same contractual arrangements since 2016.
Bilborough Medical Partnership is a partnership of four GPs (two male; two female); one of whom does not work at the practice. A further GP partner works from the practice on an occasional basis but does not provide any regular booked clinical sessions from the practice. These two partners are part of the IMH Group which manages a network of primary care sites across the country. The partnership contracts IMH to provide the practice’s support services including finance, recruitment and IT support. Responsibility for compliance with legal requirements is retained by the partnership as the provider registered with the CQC.
Bilborough Medical Practice is situated in an area of high deprivation falling into the second most deprived decile. Income deprivation affecting children and older people is similar to the local clinical commissioning group (CCG) average and above the national average.
The clinical staff comprises of two GPs (one male; one female), a pharmacist, an advanced nurse practitioner, two nurse practitioners, a practice nurse, a healthcare assistant and a phlebotomist. The clinical team is supported by a practice manager, an assistant practice manager and a team of reception and administrative staff.
The practice is open between 8.30am and 6.30pm Monday to Friday. When the practice is closed out-of-hours GP services are provided by Nottinghamshire Emergency Medical Services (NEMS) which is accessed by telephoning the NHS111 service.
Updated
14 August 2018
We carried out an announced comprehensive inspection of Bilborough Medical Centre in April 2018; the practice was rated as inadequate overall and we took urgent action in line with our enforcement procedures to impose the following conditions on the provider’s registration:
- Condition 1 -The registered provider must, with immediate effect, significantly strengthen the clinical leadership and oversight arrangements at Bilborough Medical Centre to support compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider must provide the Care Quality Commission with evidence to support the changes made by 5pm on Monday 23 April 2018.
- Condition 2 -The registered provider must review and assess the competencies of all nursing staff working within Bilborough Medical Centre to check that they have the required knowledge, skills and competencies to undertake their roles. The registered provider must provide the Care Quality Commission with evidence to support this by 5pm on Wednesday 25 April 2018.
- Condition 3 - The registered provider must, with immediate effect, review consultations, prescribing and patient records to ensure that patients have not come to harm with regards to concerns found in relation to the consultations and prescribing by the nurse practitioners. The registered provider must provide the Care Quality Commission with evidence to support this by 5pm on Wednesday 25 April 2018.
- Condition 4 -The registered persons must ensure that medicines reviews are carried out for each patient prescribed high risk drugs by no later than 5pm on Wednesday, 25 April 2018.
- Condition 5 -The registered persons must provide the Care Quality Commission with written documentation that sets out their arrangements for ongoing monitoring of patients being prescribed high risk drugs by no later than 5pm on Friday, 27 April 2018
- Condition 6 -The registered persons must carry out a review of all abnormal test results received up to and including Friday 20 April 2018 and ensure that the patients concerned are contacted no later than 5pm on Wednesday, 25 April 2018.
- Condition 7 - The registered persons must provide the Care Quality Commission with written documentation that sets out their arrangements for the ongoing monitoring of abnormal test results and ensuring that patients are contacted without delay by no later than 5pm on Friday, 27 April 2018
- Condition 8 - Unless given prior written permission by the Care Quality Commission, the registered persons must not register any new patients at Bilborough Medical Centre unless those patients are the newly born babies, newly fostered or adopted children of patients already registered at Bilborough Medical Centre.
We carried out an unannounced focused inspection at Bilborough Medical Centre on 24 May 2018. This inspection was undertaken in response to continuing concerns about the service being provided. Bilborough Medical Centre was not rated as part of this inspection. The overall rating for Bilborough Medical Centre remains inadequate.
At this inspection we found:
•Care and treatment was not always delivered according to evidence-based guidelines. Records of clinical consultations were not always sufficiently detailed.
•Prescribing was not always undertaken in line with guidelines.
•Significant events and incidents were not always fully investigated and addressed.
•Arrangements to ensure that staff were providing safe, quality care were not operated effectively.
•There were not enough appointments to meet the needs of patients.
•Staff did not always feel supported to raise concerns and were not always assured these would be addressed.
This service will remain in special measures. Services placed in special measures will be inspected again within six months of being placed into special measures. 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 further 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