Archived: The Molebridge Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Molebridge Practice on 26 August 2015. Overall the practice is rated as inadequate. Specifically, we found the practice to be inadequate for providing safe and well led services. The practice was also inadequate for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia). The practice required improvement for providing effective and responsive services. It was good for providing a caring service.

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

• The practice worked closely with other organisations and with local community services in planning how care was provided to ensure that they met people’s needs.
• The practice provided care to a high number of vulnerable patients within the local community.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Appropriate recruitment checks on staff had not been undertaken prior to their employment. Staff in key roles had been employed without recruitment checks being undertaken.
• Staff felt well supported but had not always received training appropriate to their roles. Further training needs had not always been identified and planned. Some staff had not received an induction or regular appraisal of their performance.
• Medicines were not well managed within the practice and the practice could not be sure that all medicines were safe for use. There was a lack of processes for monitoring expiry dates and storage temperatures of medicines. Prescription pads were not stored securely.
• Emergency equipment was poorly maintained and monitored.
• There was a lack of safeguarding arrangements in place to protect vulnerable adults and children. Staff had not received training in the safeguarding of vulnerable adults. Clear policies were not in place to provide support and guidance to staff in the safeguarding of vulnerable adults and children.
• Risks to staff, patients and visitors were not always formally assessed and monitored.
• There was a lack of reporting of incidents, near misses and concerns. There was minimal evidence of learning and communication with staff.
• Meetings within the practice were informal. There were no agendas for meetings and minutes were often not recorded.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure criminal records checks via the Disclosure and Barring Service are undertaken for all staff who are assessed as requiring a check, such as staff who act as chaperones.
• Ensure that medicines are securely stored and that fridge temperatures are monitored to ensure the cold chain is maintained.
• Ensure the security and tracking of blank prescription pads at all times.
• Ensure staff have access to adequate and well maintained emergency equipment.
• Ensure arrangements are in place to safeguard vulnerable adults and children from abuse.
• Ensure clear processes for the recording, review and learning from significant events, incidents and complaints.
• Ensure there are formal governance arrangements in place, including systems for assessing and monitoring risks and the quality of the service provision.
• Implement systems to ensure all clinicians are kept up to date with national guidance and clinical guidelines.
• Ensure audits of clinical practice are undertaken and that audit cycles are completed.
• Ensure assessments of risk are undertaken and that recommendations are implemented, in order to reduce the risk of exposure of staff and patients to legionella bacteria.
• Ensure the availability of appropriate sharps containers and the correct labelling of sharps containers in use.
• Replace expired spillage kits and other expired consumables within the practice.
• Ensure rehearsal of the practice fire evacuation procedures.
• Ensure staff undertake training to meet their needs, including training in the safeguarding of vulnerable adults, health and safety, fire safety, chaperoning, the Mental Capacity Act 2005 and infection control.
• Provide opportunities for all staff to receive induction, regular supervision and appraisal.
• Ensure records of practice and multidisciplinary meetings are kept and reviewed.

In addition the provider should:

• Ensure the practice gathers feedback from patients by conducting a patient survey which is accessible to the whole practice population.
• Develop an action plan to ensure findings from the infection control audit are reviewed and implemented.
• Define parking spaces within the practice car park for patients with a disability.
• Provide signage to promote the practice chaperone service within consulting rooms.
• Utilise the practice electronic record system to alert staff to patients associated with children or adults who have been identified as being at risk of abuse.
• Utilise translation services and information leaflets in different languages to provide support to patients whose first language is not English.
• Continue to regularly review the practice’s opening hours to ensure they meet the needs of patients.
• Develop a locum information pack to support locum GPs within the practice

On the basis of the ratings given to this practice and the concerns identified at this inspection we are taking enforcement action and are placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice