Updated 3 November 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dogsthorpe Medical Centre on 18 April 2016. Overall the practice is rated as inadequate.
We had identified a number of shortfalls at our previous inspection in May 2015 and found that the practice required improvement in all areas and across all population groups. We issued two requirement notices under the Health and Social Care Act 2014 as a result. During this inspection, we found that the practice had taken some action to address the shortfalls: infection control audits were now routinely undertaken, clinical audits were of better quality, whole practice meetings were being held and recruitment checks were more robust for permanent staff. However, inadequate action had been taken to monitor significant events, to improve patient access, to increase the uptake of health checks for people with learning disabilities and to facilitate patient involvement.
Our key findings across all the areas we inspected were as follows:
- According to the NHS GP Survey 63% of patients would recommend the surgery to someone new to the area, making it among the worst scores nationally.
- Patients told us they struggled to get through to the practice on the telephone and also to get an appointment. They reported that they rarely saw the same GP. According to the NHS GP Survey only 23% of patients saw their preferred GP.
- Feedback from district nurses and care home managers about the practice was poor. One home manager told us that many GPs visited their residents, which meant a lack of continuity in their care and district nurses told us that getting GPs to undertake home visits was difficult.
- Staffing at the practice was not stable. One manager was on long-term sick leave and the provider was relying on staff from another service to provide additional support. Recruitment of GPs had been difficult and the practice relied on seven locum GPs to cover vacant shifts. The registered manager only visited every couple of months, despite being accountable for the practice’s performance, and being the named GP for a number of patients.
- Significant events were not adequately managed or recorded.
- The practice had very high exception reporting. This indicated that some patients were not receiving adequate long term condition management.
- A high number of patients on the practice’s avoiding unplanned admission register did not have a care plan in place and multi-disciplinary meetings were held infrequently. Therefore it was not clear how patients’ needs were being monitored and planned for.
- Bowel and cancer screening rates for patients were low compared to local and national averages.
- Antibiotic prescribing to patients was high and the practice was the third highest prescriber of antibiotics in its local CCG area.
- Health checks for patients with learning disabilities were low, and had not improved since our previous inspection almost a year ago.
- The practice did not have a formalised system to keep all clinical staff up to date and to share relevant and current evidence based guidelines such as National Institute for Health and Care Excellence (NICE).
- Not all staff undertaking chaperone duties had been risk assessed to decide whether they needed a disclosure and barring check.
- Patients were not involved in decisions about the range and quality of the service provided by the practice
- The practice’s policies in relation to health and safety, and infection control were not being followed by staff.
- The provider had brought in part time practice management support from another local practice and these staff were working hard to address some of the issues raised at our last inspection. The provider had also identified a GP who was leading on clinical improvement: they were engaged and highly regarded by other staff at the practice.
- Staff received good training and were supported in their professional development.
- Safeguarding procedures were robust and staff took action where they had concerns.
The areas where the provider must make improvements are:
- Improve the recording and monitoring of significant events, incidents and near misses.
- Risk assess the need for staff who chaperone to have a disclosure and barring check.
- Ensure all clinicians are kept up to date with national guidance and guidelines, including those issued by the National Institute for Health and Social Care Excellence.
- Implement proactive care planning for all patients on the practice’s admissions avoidance register.
- Ensure there is adequate clinical cover across both sites of the practice.
- Improve processes for making appointments and increase the number of appointments available to patients.
- Increase the number of health checks provided to people with learning difficulties.
- Ensure that the practice’s policies in relation to health and safety, and infection control are followed by staff.
- Involve patients in decisions about the range and quality of services provided by the practice.
The areas where the provider should make improvement are
- Ensure that patient safety incidents are reported to the National Reporting and Learning System.
- Ensure that safety updates from the MHRA are received by the practice, and then actioned if relevant.
- Ensure that regular fire drills are carried out.
- Ensure that all staff, including the practice manager, receive regular appraisal of their performance.
- Increase the number of multi-disciplinary meeting that are held so that patients’ needs are fully planned for and co-ordinated.
- Provide appropriate seating for patients with mobility problems
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.
Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice