Naseby Medical Centre

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We assessed 4 quality statements in this key question: person-centred care, care provision, integration and continuity, providing information and equity in experience and outcomes. We did not assess the other quality statements and the score for these remains unchanged from the previous inspection. At our last assessment, we rated this key question as requires improvement. At this assessment, the rating remains the same.

We found that the practice did not always provide person-centred care and the management of patients with long-term conditions was inadequate. The provider did not work in partnership with other stakeholders to address the issues that resulted in suspension of their registration. The provider did not always provide patients with access to their own health records.
 

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

During our previous inspection we identified that care plans did not always reflect the physical, mental, emotional, and social needs of patients including those related to protected characteristics under the Equality Act. We found that the management of patients with long-term conditions was inadequate. Patients were not reviewed in a timely way; abnormal test results were not acted upon and patients with poorly controlled disease were not managed in a proactive way to improve their health.

The evidence reviewed during this inspection was not sufficient to demonstrate that in designing systems and processes the provider placed the patient at the centre of their care. The provider had not reflected on how the delayed, incomplete or absent care provided by Naseby Medical Centre had impacted patients as individuals or considered how this type of insight could inform the development of more patient‑centred services.
 

During our previous inspection we found that the provider did not have effective processes to review and action test results and clinical correspondence in a systematic and timely manner.

During this inspection we were not assured that robust, effective and efficient systems were in place for the management of correspondence, test results and referrals. A ‘Standard Operating Procedure for Receiving Letters’ did not clearly explain which staff members were responsible for each part of the process and leaders were unable to explain this to us. The timeframes in which staff would be expected to respond to both urgent and routine correspondence were longer than is generally accepted best practice. They were not supported by any evidence, for example a capacity / demand analysis which would show the average number of correspondences per staff member, how long they required to respond to them in a timely manner and correlate this with the amount of administrative time allocated. There were no systems in place to ensure that correspondence was reviewed if a staff member was on leave for 5 or more consecutive days.

A ‘Blood Test Protocol’ was provided to illustrate how blood test results would be received, reviewed and actioned. This protocol contained lax terminology that could be misinterpreted such as “it is good practice to at least glance at your results every working day.” This did not make it clear that a clinician must or should review their results inbox every working day in order to identify and action urgent results. Timeframes within this protocol for the actioning of urgent results were too long and risked patients coming to harm from delayed action in response to abnormal results. The management process for other types of test results such as imaging, was not included in this protocol.

No evidence was provided that there was an agreed, effective and efficient pathway for the management of referrals or that relevant administrative staff had been trained in the system. We were not assured the provider would have appropriate numbers of suitably trained staff to manage the volume of correspondence, test results and referrals. The arrangements for oversight of these processes by the leadership team were unclear.

The provider had taken the decision that locum doctors would provide the majority of acute and urgent care whilst the GP partners would focus on managing long-term conditions. Following our inspection an updated plan regarding staffing was provided which utilised 4 different pharmacists and 3 different locums to provide clinics over the course of a week. Whilst this did increase capacity, the fragmented nature of this cover reduced the likelihood of continuity of care especially for patients with acute conditions who may require multiple appointments with different locum GPs in order to receive a diagnosis. The proposed system increased the risk of omissions and duplications in assessment and treatment as it was very dependent on comprehensive record keeping and communication between clinicians who all work on different days and not sufficiently robust to ensure continuity and oversight of clinical care.
 

During our previous inspection we identified that an unusually large number of patient record entries were blocked from online viewing. This meant they would not appear on the patient’s NHS App. When we asked leaders about this, they said some patients requested information to be blocked for privacy reasons, however there was not an explanation for why records had been blocked in every case. There was a policy in place at this time which required clinicians to document the reason why online access was restricted, however this was not being followed.

A new ‘Safeguarding policy for blocking online access’ was produced, it was more detailed and had the same core principle of transparency; that reasons for blocking online access for patients to their own records must be clearly documented. However, as the provider did not have plans to monitor compliance with this policy it did not provide assurance that patients’ online access would not be unduly restricted.
 

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Plans submitted during this inspection showed that the provider intended to provide a remote-only pharmacy service which would only offer telephone or video call appointments. This was a temporary situation due to a lack of clinical space until building work had been completed. However, the lack of clinical rooms meant that if a pharmacist was concerned about a patient and wished to review them in-person they would have to be offered an emergency appointment with the doctor or nurse who was currently using the clinical rooms. A purely remote service such as this disadvantages patients who cannot use the telephone or who are digitally excluded. No provision was made for these patients to be able to book in-person appointments.

Following our inspection extra clinic rooms had been sourced at another local practice half a mile away. The provider told us that these rooms would be used by locum GPs who would be providing the majority of urgent appointments, as well pharmacists if required. This would necessitate extra travel for some patients and may disadvantage certain patient groups such as neurodiverse people who would be attending unknown premises, with staff they did not know, navigating a new building and different waiting areas. The provider gave no information about whether reception staff would be available to check patients in at this other practice and monitor patient safety and security whilst they were on the premises, as would happen in the waiting room of their own practice. No evidence was provided to show that a risk assessment had been completed to identify and mitigate the potential risks to patients in this situation. No evidence was provided to show that accommodations had been made for these patient groups.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.