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Archived: The Village Medical Centre Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 19 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Village Medical Centre on

5 September 2016. Overall the practice is rated as inadequate.

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

  • Patients were at potential risk of harm because systems and processes were not in place to keep them safe. For example not all appropriate recruitment checks on staff had been undertaken prior to their employment, there had been no risk assessments carried out in relation to health and safety, fire safety, infection control or legionella since 2012, there were no records to show whether staff were immunised against infectious diseases such as Hepatitis B.
  • The practice was mostly carpeted including the treatment room used by the practice nurse and no spill kits available.
  • There were no clear records to show that staff had received mandatory training such as

safeguarding, infection control, Information Governance or fire safety.

  • All reception staff acted as chaperones but had received no formal training and were not DBS checked.
  • Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.
  • Patient outcomes were hard to identify as no reference had been made to audits or quality improvement for three years and there was no evidence that the practice was comparing its performance to others either locally or nationally.
  • The practice had no clear leadership structure, insufficient leadership capacity, no day to day supervision and support of staff and no formal governance arrangements.
  • There were no policies and procedures which had been personalised to the practice. There was no repeat prescribing policy available and no policy or process for dealing with safety alerts.
  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
  • The lead GP was working with GP locums due to a difficulty in the recruitment of new partners.

We identified regulatory breaches within the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection . They are Regulation 12 Safe Care and Treatment, Regulation 17 Good Governance, Regulation 18 Staffing and Regulation 19 Fit and Proper Persons.The Care Quality Commission is unable to take enforcement action against the provider regarding these breaches as they are registered with us as a partnership but should be registered as a sole provider. We have made NHS England and the Clinical Commissioning Group aware of this position.

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 service from operating.

Special measures will give people who use the service the reassurance that the care they get should improve. The provider must take urgent action to become registered.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Inadequate

Updated 19 January 2017

The practice is rated as inadequate for providing safe services and improvements must be made.

Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.

  • Patients were at risk of harm because systems and processes were not in place. For example not all appropriate recruitment checks on staff had not been undertaken prior to their employment such as references, employment history, application forms and CVs. There had been no risk assessments carried out in relation to health and safety, fire safety, infection control or legionella since 2012, there were no records to show whether staff were immunised against infectious diseases such as Hepatitis B. After the inspection the GP told us of his Hepatitis B status but we were unable to evidence this on the day.
  • All reception staff acted as chaperones but had received no formal training and had not received a check with the Disclosure and Barring Service or carried out a risk assessment to justify their reason. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
  • There was no repeat prescribing policy available to staff and no policy or process for dealing with safety alerts. A new member of staff was requesting prescriptions but didn’t understand questions asked about alerts on the clinical system when issuing prescriptions.
  • There were no clear records to show that staff had received mandatory training such as safeguarding, infection control, Information Governance or fire safety.
  • One of the treatment rooms used by the practice nurse was carpeted and we were told by the nurse and some members of staff that there was no spill kits availa

    ble. After the inspection the GP told us that there were spill kits but we were unable to evidence this on the day.

Effective

Inadequate

Updated 19 January 2017

The practice is rated as inadequate for providing effective services and improvements must be made.

  • Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally. There had been no clinical audit carried out for three years.
  • There was limited recognition of the benefit of an appraisal process for staff and little support for any additional training that may be required.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 19 January 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Requires improvement

Updated 19 January 2017

The practice is rated as requires improvement for providing responsive services

  • Patients could get information about how to complain in a format they could understand. However, there was no evidence that learning from complaints had been shared with staff.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs
  • The practice did not have a hearing loop available but told us that the CCG were in the process of purchasing one for each practice that did not have one.

Well-led

Inadequate

Updated 19 January 2017

The practice is rated as inadequate for being well-led.

  • The practice did not have a clear vision and strategy. Staff were not clear about their responsibilities in relation to the vision or strategy.
  • There was no clear recruitment or induction process.
  • There was no clear leadership structure and staff did not feel supported by management.
  • The practice had a number of policies and procedures to govern activity, but these were not personalised to the practice and were not regularly reviewed.
  • The practice did not hold regular governance meetings and issues were discussed at ad hoc meetings.
  • The practice had not proactively sought feedback from staff. The practice had an active patient participation group.
  • Staff told us they had not received regular performance reviews and did not have clear objectives.
  • The practice had no clear leadership structure, insufficient leadership capacity, no day to day supervision and support of staff and no formal governance arrangements.
Checks on specific services

People with long term conditions

Inadequate

Updated 19 January 2017

The provider was rated as inadequate for providing safe care and inadequate overall. The issues identified affected all patients including this population group.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority
  • The percentage of patients with diabetes whose last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 88% and above the CCG average of 82% and the national average of 78%. However the practice exception rate was 13% compared to the CCG average of 6%.
  • Longer appointments and home visits were available when patients needed them.
  • Structured annual reviews were undertaken to check that patients’ health and care needs were being met.
  • Performance for mental health related indicators showed that, for example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 100% compared to the national average of 88%, however the practice exception rate was 40% compared to the CCG average of 12.55%

Families, children and young people

Inadequate

Updated 19 January 2017

The provider was rated as inadequate for providing safe care and inadequate overall. The issues identified affected all patients including this population group.

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.
  • Immunisation rates were 100% take up for most of the standard childhood immunisations.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • 83% of women aged between 25 and 64 had their notes recorded that a cervical screening test had been performed in the preceding five years which was similar to the national average of 82%.
  • The practice offered open access for all children.
  • The practice offered a confidential chlamydia screening service.

Older people

Inadequate

Updated 19 January 2017

The provider was rated as inadequate for providing safe care and inadequate overall. The issues identified affected all patients including this population group.

  • All patients over the age of 75 had a named GP.
  • All elderly patients were offered a care plan.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice embraced the Gold Standards Framework for end of life care. This included supporting patients’ choice to receive end of life care at home.
  • The practice offered dementia screening and appropriate referral to secondary care.

Working age people (including those recently retired and students)

Inadequate

Updated 19 January 2017

The provider was rated as inadequate for providing safe care and inadequate overall. The issues identified affected all patients including this population group.

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • The practice was proactive in offering online services as well as a range of health promotion and screening that reflects the needs for this age group.
  • Advice and support was offered to patients regarding smoking cessation, alcohol consumption and weight management.
  • Telephone consultations were available for those patients that required them.
  • Extended hours were offered two mornings each week.

People experiencing poor mental health (including people with dementia)

Inadequate

Updated 19 January 2017

The provider was rated as inadequate for providing safe care and inadequate overall. The issues identified affected all patients including this population group.

  • The practice recorded on a patient record if they were a carer but they did not have a register of carers therefore they were unable to tell us how many carers were registered with the practice.
  • The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health.
  • 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84%. The practice exception rate was 5% compared to the CCG average of 8%.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations
  • Performance for mental health related indicators showed that, for example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 100% compared to the national average of 88%, however the practice exception rate was 40% compared to the CCG average of 12.55%.

People whose circumstances may make them vulnerable

Inadequate

Updated 19 January 2017

The provider was rated as inadequate for providing safe care and inadequate overall. The issues identified affected all patients including this population group.

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • Although staff had not received training in safeguarding they knew how to recognise signs of abuse in vulnerable adults and children. Clinical staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.