Dr Hugh Wright Also known as Maida Vale Medical Centre

We carried out an announced comprehensive inspection of Dr Hugh Wright, also known as Maida Vale Medical Centre, on 11 February 2020 when the practice was rated inadequate overall (inadequate in safe and well-led and requires improvement in effective, caring and responsive) and placed in special measures. At that inspection we issued warning notices for breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance).

The full comprehensive report on the 11 February 2020 inspection can be found by selecting the ‘reports’ link for Dr Hugh Wright on our website at www.cqc.org.uk.

At this inspection on 4 May 2020, we undertook an announced desk-based focused inspection to follow-up on the warning notices issued on 2 March 2020 in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). As part of the desk-based inspection the provider submitted documentary evidence to demonstrate compliance with the findings of our previous inspection and we spoke with the Lead GP and a salaried GP by telephone. We did not review the ratings awarded to this practice at this inspection.

At this inspection we found that the provider had made improvements and had implemented systems and processes in relation to the management of patients on high-risk medicines, patient safety alerts and clinical supervision and oversight. Although improvements had been made around safeguarding, further improvement was required in relation to the review of safeguarding risk registers and safeguarding training.

We are mindful of the impact of COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

The areas where the provider should make improvements are:

1. Review the safeguarding children and adult risk registers.
2. Review the safeguarding children and adult training requirements for staff.

The service will remain in special measures and this will be reviewed at a follow-up comprehensive inspection in line with our inspection criteria. This 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 decisions are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Dr Hugh Wright on 11 February 2020 as part of our inspection programme.

The practice was inspected in October 2015 where they were rated Require Improvement and in July 2017 where they rated Good.

We decided to undertake an inspection of this service following our annual review of the information available to us. This inspection looked at the following key questions:

• Safe
• Effective
• Caring
• Responsive
• Well-led

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.
• The practice did not have appropriate systems in place for the safe management of medicines.
• There was no formal process in place to check/ensure patient safety alerts were actioned by clinical staff.
• Significant events were not always reported and recorded appropriately, and some staff were not aware of the location of the incident recording form. There was no evidence that any learning from incidents was discussed with the whole team.

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

• The lead GP was no longer saw patients and did not attend the practice on a regular basis, however the practice had not reviewed their clinical and safeguarding role.
• The overall governance arrangements were ineffective. The practice did not have any formal clinical meetings and there was no evidence of clinical oversight.
• While the practice had a vision, that vision was not supported by a strategy.
• There was no program of quality improvement and there was minimal evidence of learning, reflective practice and innovations.
• The practice did not have clear and effective processes for managing risks, issues and performance.

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

We rated the practice as requires improvement for providing effective services because:

• There was limited monitoring of the outcomes of care and treatment.
• Childhood immunisations and cervical smear rates were lower than local and national targets

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

• We found complaints were not always handled in line with the practices complaints policy.
• Patients could not always access care and treatment in a timely way.

We rated the practice as requires improvement for providing caring services because:

• The GP patients survey results were lower than the CCG and England averages

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:

• Ensure complaints are responded to in line with the practices complaints policy,

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