Archived: The Village Medical Centre

Updated 19 January 2017

As part of the Care Quality Commission (Registration) Regulations 2009: Regulation 15 we noted GP partners registered with the Care Quality Commission as the partnership did not reflect the GP partners currently at the practice. We were told this would be addressed following the inspection and the appropriate applications and notifications submitted.

The Village Medical Centre provides primary medical services in Littleborough near Rochdale from Monday to Friday. The practice is open between 7.30am and 6pm Monday and Tuesday and 8.30am until 6pm, Wednesday, Thursday and Friday. The first appointment of the day with a GP is 9:00am and the last appointment with a GP is 6pm with the last two appointments for emergencies.

The Village Medical Centre is situated within the geographical area of Heywood, Middleton and Rochdale Commissioning Group (CCG).

The practice has a Personal Medical Services (PMS) contract. The PMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

The Village Medical Centre is responsible for providing care to 4259.

The practice consists of one male GP currently being supported by locum doctors as two salaried GPs had recently left the practice. There is one practice nurse and one phlebotomist. The practice is supported by a practice manager and an administration team that includes receptionists.

When the practice is closed patients were directed to the out of hour’s service which is provided by BARDOC.

The practice belongs to a group of local practices who provide access to a GP and practice nurse at evenings and weekends.

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

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%

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.

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.

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.

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%.

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.