Background to this inspection
Updated
3 August 2020
St Werburgh Medical Practice provides general medical services to approximately 11,150 patients. The two partners who are accountable for the service are also accountable for eight other registered locations providing a range of regulatory activities. This report relates only to the St Werburgh Medical Practice location. One of the partners is a GP and the other is non-clinical, neither of the partners work routinely on site at St Werburgh Medical Practice.
Data available to the Care Quality Commission (CQC) shows the number of patients from birth to 18 years old served by the practice is slightly higher than the average for England and other local practices. The number of patients aged 65 years and over is below the England average. The percentage of registered patients suffering deprivation (affecting both adults and children) is lower than the average for England (fourth most deprived decile).
The practice staff consists of a clinical lead GP, who is supported by five long term locums. This amounts to a whole time equivalent of 2.3 GPs (based on eight sessions per week). They are supported by an advanced nurse practitioner, one diabetic specialist nurse, a locum respiratory nurse. This amounts to the whole time equivalent of 1.5 nurses. There are two healthcare assistants, an onsite management team and administrative staff and patient services staff.
This service is provided at the following sites and during this inspection we only visited St Werburgh Medical Practice:
St Werburgh Medical Practice, 98 Bells Lane, Hoo, Rochester, Kent, ME3 9HU.
Stoke Village hall, Mallard Way, Lower Stoke, Rochester, Kent, ME3 9ST.
The Healthy Living Centre, Balmoral Gardens, Gillingham, Kent, ME7 4PN.
Patients requiring a GP outside of normal working hours are advised to contact the NHS GP out of hours service NHS 111. Patients are informed how to access this service through the practice website and leaflet and by a recorded telephone message if they call the practice outside normal working hours.
For further details please see the practice website:
Updated
3 August 2020
We carried out an announced comprehensive inspection at St Werburgh Medical Practice on 20 November 2018. The overall rating for the practice was requires improvement. The full comprehensive report on the November 2018 inspection can be found by selecting the ‘all reports’ link for St Werburgh Medical Practice on our website at www.cqc.org.uk.
After our inspection in November 2018 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.
We carried out an announced comprehensive follow-up inspection on 5 and 6 November 2019 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 20 November 2018. This report covers findings in relation to those requirements.
This practice is now rated as Inadequate overall.
The key questions at this inspection are rated as:
Are services safe? – Inadequate
Are services effective? – Inadequate
Are services caring? – Requires Improvement
Are services responsive? – Inadequate
Are services well-led? – Inadequate
We rated the practice as inadequate for providing safe services because:
- The practice’s systems, processes and practices did not always help to help keep people safe and safeguarded from abuse.
- Staff did not always have the information they needed to deliver safe care and treatment to patients.
- The arrangements for managing medicines in the practice had not sufficiently improved and did not always keep patients safe.
We rated the practice as inadequate for providing effective services because:
- Care and treatment were not always delivered in line with current legislation, standards and evidence-based guidance.
- Quality improvement activity was insufficient.
- Two members of staff had not received a regular appraisal.
- Clinical supervision for relevant staff was limited.
We rated the practice as requires improvement for providing caring services because:
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Since our last inspection in November 2018, results of the national GP patient survey relating to patients’ experience of services provided at St Werburgh Medical Practice had deteriorated for two indicators.
We rated the practice as inadequate for providing responsive services because:
- The practice did not always have enough staff to deliver services to meet patients’ needs.
- Patients were no longer able to access care and treatment from the practice within an acceptable timescale for their needs.
- Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment as well as their experience of services at St Werburgh Medical Practice had deteriorated and was below (significantly in some cases) than local and national averages.
- Almost all patient feedback received by the Care Quality Commission indicated they found it difficult to get through to the practice by telephone and were not always able to book appointments that suited their needs.
We rated the practice as inadequate for providing well-led services because:
- Leadership was complex and did not always function as intended by the provider.
- Improvements to governance arrangements were insufficient.
- Improvements to their processes for managing risks, issues and performance were insufficient.
- The practice had not acted sufficiently on the feedback they had received from the public.
- Systems and processes for learning and continuous improvement were not yet sufficiently effective.
The areas where the provider must make improvements are:
- Ensure care and treatment is provided in a safe way to patients.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
The areas where the provider should make improvements are:
- Revise how patients with disabilities can summon assistance to open the entrance door of the Stoke Village Hall branch surgery and consider carrying out a disability risk assessment of the sites where services are provided.
I am placing the service in special measures. Services placed in special measures will be inspected again in 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 reassurance that the care they get should improve.
Dr Rosie Benneyworth MB BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care
Please refer to the detailed report and the evidence tables for further information.