Archived: Dogsthorpe Medical Centre

Letter from the Chief Inspector of General Practice

This was the third inspection that we had carried out at First Health (Peterborough) UK – Dogsthorpe Medical Centre.

On 19 May 2015 we carried out a comprehensive inspection of First Health (Peterborough) UK – Dogsthorpe Medical Centre. The practice was rated as requires improvement for providing safe, effective, caring, responsive and well led services. As a result of the findings on the day of the inspection the practice was issued with requirement notices for regulation 17 (Good governance) and regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

On 18 April 2016 we carried out a second comprehensive inspection. This inspection was responsive to a whistleblower raising concerns about the practice and to check if the practice had made the changes identified in May 2015. The practice was rated inadequate for providing safe, effective, responsive and well led services, and requires improvement for providing caring services.

At our April 2016 inspection we found that the practice had taken some action to address a number of the shortfalls previously identified. However, inadequate action had been taken to assess or act on other risks, such as the monitoring of significant events and improving patient access. Patients were at risk of harm because systems and processes were not in place to keep them safe. The systems and processes in place to ensure good governance were ineffective and did not enable the provider to assess and monitor the quality of the services and identify, assess and mitigate against risks to people using services and others. As a result of the findings on the day of the inspection the practice was issued with requirement notices for regulation 9 (Person-centred care) and regulation 13 (Safeguarding service users from abuse and improper treatment), and a warning notice for regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The practice was placed into special measures for six months.

On the 14 September 2016, we conducted a focused inspection to ensure that the practice had made the required improvements detailed in the warning notice that had been issued on 17 May 2016 following our inspection of 18 April 2016.

Our findings from this inspection are as follows:

• The practice was unable to demonstrate that they had made sufficient improvements to drive all of the changes necessary for the practice to meet the requirements of Regulation 17 (Good governance) to keep patients safe.
• The practice did not maintain appropriate records to demonstrate that significant events had been analysed, investigated and reviewed at a later date. Learning outcomes were not detailed and showed a lack of clinical oversight in ensuring that the significant events did not reoccur.
• Not all staff we spoke with felt confident that robust arrangements were in place to safeguard children and vulnerable adults from abuse.
• The information needed to plan and deliver care and treatment was not always available to relevant staff in a timely and accessible way through the practice’s patient record system. The practice failed to review pathology results and discharge paperwork from secondary care providers in a timely manner, and the management of correspondence was not always delegated to a staff member who was appropriately trained and qualified.
• Patients we spoke to on the day of inspection told us that they were unable to get appointments when they needed them. We were also told that same day appointments were not always available for children.

Following our focused inspection on 14 September 2016 we took urgent action to suspend First Health (Peterborough) UK from providing general medical services at Dogsthorpe Medical Centre.

This report covers our findings in relation to our focused inspection. You can read our findings from our last inspections by selecting the ‘all reports’ link for Dogsthorpe Medical Centre on our website at www.cqc.org.uk

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

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