Archived: Dr Christopher John George Wright Also known as Deerbrook Surgery

Dr Christopher John George Wright is a provider registered with CQC. We carried out this announced comprehensive inspection on 22 October 2019 to follow up concerns raised at our inspection on 13 February 2019. Following the February inspection this service was placed in special measures. We carried out a focussed inspection in August 2019 to check compliance with enforcement action taken.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected

• information from our ongoing monitoring of data about services and

• information from the provider, patients, the public and other organisations.

We have rated this practice as Requires Improvement overall and Requires Improvement for all population groups.

We rated the practice as Requires Improvement for providing safe services because:

• There was no formal process for reviewing patients prescribed one high risk medicine to monitor their health.

• There was no system in place to ensure blood test referrals were completed or recorded accurately.

• The practice was correctly monitoring indemnity arrangements and professional registrations of clinical staff.

• Staff had all completed safeguarding, fire and infection control training.

• Safeguarding arrangements and the mechanisms for reporting significant events were clear.

We rated the practice as Requires Improvement for providing well-led services because:

• Staff informed us that there was limited action taken in response to the lack of clinical and non-clinical staff reported by staff.

• The leadership governance and culture did not always support the delivery of high-quality person-centred care.

• The arrangement for governance and performance management were not fully clear or do not always operate effectively.

• There were now clear succession plans in place to ensure the future sustainability of the service.

• There was effective oversight of staff training and recruitment information.

• There was action taken in response to feedback from staff and patients.

We rated the practice as Requires Improvement for providing Effective services because:

• Performance indicators for patients with childhood immunisation rates and cervical screening had not met the targets set by NHS England. Following the inspection the practice provided unvalidated data which showed that they were now meeting immunisation targets and had improved their work in these areas overall.

• There was clear care planning for patients.

• The practice had systems to review and monitor the quality of care provided by locum staff and all staff had been appraised.

• All staff had completed the required training to meet their learning needs that covered the scope of their work,

• The practice undertook effective joint working with other organisations.

We rated the practice as Good for providing Responsive services because:

• The complaints policy was accessible and had been updated. All complaints had been responded to and recorded appropriately.

• The practice was in the process of ensuring that patients had access to a female GP.

• The appointment systems were easy to use and patients were supported to access appointments.

We rated the practice as Good for providing Caring services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.

• The practice had identified 2.1% of their practice list as carers.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Undertake an assessment of how clinical incidents can be identified, recorded and analysed for improvements.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service. As this service is now rated as requires improvement, another inspection will be conducted within a further 12 months.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP Chief Inspector of Primary Medical Services and Integrated Care

Dr Christopher John George Wright is a provider registered with CQC. We carried out an inspection of the provider on 28 June 2019 to follow up concerns raised at our inspection on 21 February 2019.

At the inspection in February 2019 we found that:

• The practice was not monitoring high risk medicines in accordance with guidance and recommendations.
• The practice had not carried out a risk assessment to determine how to manage medical emergencies and did not have the full range of recommended medicines available.
• The practice had not ensured that professional registrations were reviewed.
• The practice had not ensured that all staff had appropriate medical indemnity arrangements in place and had completed appropriate training.
• Staff had not undertaken the training required for them to sufficiently carry out their role.
• The practice did not have effective systems in place to securely store and monitor the usage of prescriptions.
• There was no failsafe system in place to monitor two-week wait referrals.

At this inspection we found that:

• The provider had addressed the specific concerns raised in the last inspection.
• The practice had ensured all staff had appropriate medical indemnity arrangements in place and had completed appropriate training.
• The practice had the full list of recommended emergency medicines available.
• The practice had put measures in place to monitoring high risk medicines in accordance with guidance and recommendations.
• However, we found additionally:
• The provider had not ensured that test results were actioned in a timely manner. Two patients had not had their test results communicated to them.
• Dementia patients’ annual reviews had not been carried out for all the practice’s dementia patients.
• Medication reviews were recorded as being done but did not contain any detail of the reviews.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Dr Christopher John George Wright (The Deerbrook Surgery) is a provider registered with CQC.

We carried out an inspection of the provider on 13 February 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall and requires improvement for all population groups.

We rated the practice as inadequate for providing safe services because:

• The practice did not have appropriate systems in place for the safe management of medicines as there was no effective system in place to ensure prescriptions were securely stored and their use monitored and patients taking high risk medicines were not consistently being monitored in line with current guidance and legislation. The provider submitted details of an action plan to address concerns around high risk drug monitoring after our inspection.
• Staff had not all completed safeguarding, fire and infection control training.
• There were no systems in place to monitor indemnity arrangements or the professional registrations of clinical staff.
• Safeguarding arrangements and the mechanisms for reporting significant events were not clear.
• The practice had not carried out a risk assessment to determine how to manage medical emergencies, and did not have the full range of recommended medicines available. The provider told us that they had purchased this missing medicines after our inspection.

We rated the practice as inadequate for providing well-led services because:

• There was a lack of future planning to ensure sustainability of the services.
• Governance was lacking in key areas including safeguarding, significant event management, policy oversight and the management of medicines which meant that key areas of risk had not been adequately assessed or addressed.
• There was a lack of effective oversight of staff training and recruitment information.
• There was limited action taken in response to below average feedback or performance and limited evidence of continuous improvement or innovation.

We rated the practice as inadequate for providing effective services because:

• The practice did not have systems to review and monitor the quality of care provided by locum staff and not all staff were being regularly appraised.
• Care planning was not being used by staff working at the practice
• Staff had not completed all required training.
• Performance indicators for patients with COPD, dementia, childhood immunisation and bowel screening were below the local and national averages.
• The practice did not always undertake effective joint working with other organisations.

We rated the practice as requires improvement for responsive services because:

• Patients did not have regular access to a female GP at the practice and staff reported that they did not have adequate clinical staffing.
• The complaint policy was not immediately accessible to patients and policy staff provided to patients was out of date.
• Some patients fedback that care and treatment was difficult to access. The practice had not undertaken any action in response to below average national patient survey results around access.

These areas in effective and responsive services affected all population groups so we rated all population groups as requires improvement

We rated the practice as good for providing caring services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Continue with work to improve the quality of care provided to people with long term conditions, people experiencing poor mental health and families children and young people.
• Introduce care planning for patients with complex medical conditions so that information is shared effectively with other services.
• Consider and develop a policy around the frequency of DBS checks to be completed for staff.
• Formalise systems for recording action taken in response to patient safety alerts.
• Implement a formal process for reviewing patients discharged from hospital and assessing frailty.
• Implement systems to identify and follow up children living in disadvantaged circumstances and who were at risk.
• Put plans in place aimed at addressing issues of future sustainability.
• Take action in response to patient feedback related to access.

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 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 the reassurance that the care they get should improve.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care