The Care Quality Commission
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Archived: Gloucester House Medical Centre

Overall: Inadequate read more about inspection ratings

17 Station Road, Urmston, Manchester, Greater Manchester, M41 9JS (0161) 748 7115

Provided and run by:
Dr Masud Prodhan

All Inspections

07/08/2019

During a routine inspection

This practice is rated as Inadequate overall. (Previous ratings: October 2016 Requires Improvement. September 2017 – Good)

We carried out our first announced comprehensive inspection at Gloucester House Medical Centre on 19 July 2016 when the practice was rated as requires improvement overall. The areas where the provider was required to make improvements related to the safe and well led domains. The practice had been under pressure following major staff changes and there was fragmented leadership. Tasks were not being dealt with in a timely manner and risks associated with fire and health and safety were not dealt with appropriately.

We went back to Gloucester House Medical Centre on 25 May 2017 to check that the practice had made improvements. Improvements were demonstrated in all areas. Leadership was no longer fragmented, and staff were being supported. The practice had acted on each point highlighted at the inspection of 19 July 2016 and had introduced systems to address the concerns.

During 2018, key members of medical and managerial staff resigned from the practice and they were again in a period of instability. A new manager was employed in January 2019. However, in April 2019 the CQC received whistle blowing information from existing and previous members of staff about concerns at the practice.

The CQC undertook an annual regulatory review because of the concerns and a decision to bring forward a full comprehensive inspection was agreed. The inspection was part of our regulatory functions to check whether the provider was maintaining the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. We looked at all the domains and all the key questions at this inspection.

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.

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

  • The practice did not have clear systems and processes to keep patients safe. We found concerns around incident reporting, safeguarding, clinical record keeping, patient safety alerts, prescription protocols, and information sharing.
  • Patient consultations were not sufficiently documented to ensure that appropriate information was available to all clinicians reviewing patients. There were gaps in alert processes for safeguarding and no evidence that information about safeguarding incidents was communicated to all clinical staff.
  • The practice did not have appropriate systems in place for the safe management of medicines. Administration, pharmacy and health care staff were working outside their competencies.
  • Receptionists had not been given guidance on identifying deteriorating or acutely unwell patients. They were not aware of actions to take in respect of such patients.
  • Staff were not clear about reporting incidents, near misses and concerns and the practice did not learn and make improvements when things went wrong.

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

  • There was limited monitoring of the outcomes of care and treatment. Data showed that some patient outcomes were positive but there were areas of high exception reporting.
  • There were areas of significant negative variation in relation to antibiotic prescribing and prescribing of medicines that are addictive.
  • The practice was unable to demonstrate that all staff had the skills, knowledge and experience to carry out their roles.
  • The practice was unable to demonstrate that it always obtained consent to care and treatment.

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

  • Although staff dealt with patients with kindness and respect not all patients felt involved in decisions about their care.
  • Not all comments from patients were positive about their interactions with staff.
  • Verbally reported concerns were not escalated so that they could be dealt with and learned from.
  • Carers were not proactively identified and cared for appropriately.
  • We identified some patients who were offered treatment without appropriate explanation and this treatment was not within The National Institute for Health and Care Excellence (NICE) guidelines.

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

  • The practice was unable to organise and deliver safe services to meet patients’ needs.
  • There were several significantly negative responses from patients in the GP patient survey around access, appointments and the way they had been cared for.
  • Not all patients receiving care and treatment in a timely way.
  • Care and treatment were being provided on a reactive basis and clinics were being cancelled at short notice due to planned or unplanned periods of absence because of inconsistent locum cover.

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

  • There was insufficient practice leadership and leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
  • Leaders were not performing tasks intrinsic to their role and the requirements of the Health and Social Care Act.
  • At the time of the inspection the Provider was absent from the practice at the request of NHS England.
  • At this inspection we identified concerns that put patients at risk.
  • The practice culture did not effectively support high quality sustainable care.
  • The overall governance arrangements were ineffective.
  • The practice did not have clear and effective processes for managing risks, issues and performance.
  • The practice did not always act on appropriate and accurate information.
  • We saw little evidence of systems and processes for learning, continuous improvement and innovation.

These areas affected all population groups, so we rated all population groups as inadequate.

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

The areas where the provider must make improvements are:

  • Ensure that leaders can properly perform tasks that are intrinsic to their role
  • Ensure that all patients are treated with dignity and respect
  • Ensure care and treatment is provided in a safe way to patients
  • Ensure patients are protected from abuse and improper treatment
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure specified information is available regarding each person employed and any such action as is necessary and proportionate is taken when any member of staff is no longer fit to carry out their duties

We are taking action in line with our enforcement procedures to begin the process of preventing the provider from operating the service.

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 further action in line with our enforcement procedures to continue 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.

Dr Rosie Benneyworth BM 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.

25 May 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out our first announced comprehensive inspection at Gloucester House Medical Centre on 19 July 2016 when the practice was rated as requires improvement overall. The areas where the provider was required to make improvements related to the safe and well led domains. The full comprehensive report following that inspection can be found by selecting the ‘all reports’ link for Gloucester House Medical Centre on our website at www.cqc.org.uk.

We carried out this announced comprehensive inspection at Gloucester House Medical Centre on 25 May 2017 to check that the practice had made improvements. Improvements were demonstrated in all areas. The practice had taken action on each point highlighted at the inspection of 19 July 2016 and had introduced robust systems to address the concerns.

Overall the practice is now rated Good.

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

  • A clear leadership structure had been introduced since our inspection in July 2016. Staff said they felt supported by management and had noticed improvements in communication.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events. The practice had introduced and embedded a number of systems to minimise risks to patients and staff since our inspection in July 2016.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
  • Staff were aware of current evidence based guidance. They had been trained in the skills and knowledge they required in order to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were satisfied with the service, were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients who commented were satisfied with the appointment system and said they received continuity of care with urgent appointments available when required.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider should continue to make improvements are as follows :

  • Consider a review of care plans to ensure that patients are involved in the planning process and receive a copy of their care plan to take away.
  • Enhance the existing protocols for monitoring high risk medicines, uncollected prescriptions and the review of blood results to ensure they are failsafe. Introduce a plan to monitor when second cycles of clinical audit are due.
  • Increase the number of carers identified.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

19th July 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gloucester House Medical Practice on 19th July 2016. Overall the practice is rated as Requires Improvement.

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

  • The lead GP and practice manager described an open and transparent approach to safety and a system in place for reporting and recording significant events. The system was not formal and matters were raised via electronic notifications and learning logs.
  • Formal clinical and staff face to face meetings were not regularly taking place to discuss where things went wrong and what could be done to stop them happening again in the future.
  • Risks to patients historically were not always assessed and well managed, specifically relating to fire, infection control, systems to manage medicines, prescribing spend and health and safety in general.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • There was information on the practice website about how to make a complaint and this could be translated into different languages. Improvements were made to the quality of care if complaints or concerns were received.
  • Most patients said they could make an appointment easily with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice was located in an old building that required some attention, particularly in relation to fire hazards, but they had good facilities and the building was well equipped to treat patients and meet their needs.
  • The practice was under pressure following recent major staff changes and we saw a fragmented leadership structure. Action had been taken to provide lines of management and structure for staff and continuity of care for patients.
  • Staff felt supported by management and engaged in the process to make improvements.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

  • The provider must ensure action is taken in a timely manner when risks are identified. This includes risks identified following a fire risk assessment and a system in place to maintain health and safety requirements relating to the premises.

  • The provider must ensure that infection control procedures are fully implemented and maintained, including a legionella assessment.

  • The provider must ensure that systems are in place to formally record and report all significant events such as practice related issues and clinical related issues.

  • The provider must introduce a system to ensure all staff received patient safety alerts and any action required is clearly identified, documented and completed.

  • The provider must ensure that the fragmented leadership structure is addressed.

The areas where the provider should make improvements are :

  • The practice should monitor that NICE and other guidelines are followed, through risk assessments, audits and random sample checks of patient records.

  • The practice should satisfy themselves that all staff understand each member’s roles and responsibility, specifically in relation to health and safety, safeguarding and infection control.

  • The practice should be clear that all staff understand who is responsible for maintaining equipment, stock rotation and fridge management to ensure it is managed effectively.

  • The practice should complete the planned appraisal programme.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice