Wigmore Medical Centre

We carried out an announced comprehensive inspection at Wigmore Medical Centre on 2, 3 and 8 April 2019. The overall rating for the practice was Inadequate. The full comprehensive report on the April 2019 inspection can be found by selecting the ‘all reports’ link for Wigmore Medical Centre on our website at www.cqc.org.uk.

After our inspection in April 2019 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

We carried out an announced comprehensive follow-up inspection on 3 and 4 December 2019 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 2, 3 and 8 April 2019. This report covers findings in relation to those requirements.

This practice is now rated as Requires Improvement overall.

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Inadequate

Are services well-led? – Requires Improvement

We rated the practice as requires improvement for providing safe services because:

• The practice had made improvements to systems, practices and processes to help keep people safe and safeguarded from abuse. However, further improvements were required.
• The practice had made improvements to the way risks to patients, staff and visitors were being assessed, monitored or managed.
• Staff had the information they needed to deliver safe care and treatment. However, individual care records, including clinical data, were not always written and managed in line with current guidance and relevant legislation.
• The practice had made improvements to the arrangements for medicines management to help keep patients safe. However, further improvements were still required.

We rated the practice as requires improvement for providing effective services because:

• Care and treatment were not always delivered in line with current legislation, standards and evidence-based guidance.
• The practice had carried out improvement activities and exception rates for Quality and Framework Outcomes (QOF) indicators were now in line with or lower than local and national averages. However, improvements to performance for one diabetes indicator and the hypertension indicator were now required.
• Staff were now up to date with all essential training.
• Staff were now receiving regular appraisals.

We rated the practice as good for providing caring services because:

• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Results of the national GP patient survey had improved in relation to patient satisfaction scores for their overall experience of Wigmore Medical Centre.

We rated the practice as inadequate for providing responsive services because:

• The limited access for people with mobility issues and the lack of an accessible patient toilet at the branch surgery remained and did not comply with The Equality Act 2010.

We rated the practice as requires improvement for providing well-led services because:

• The practice had taken effective action to adequately manage risks found at our last inspection in April 2019. However, further improvements were required.
• The practice had taken effective action to adequately manage and improve performance that, at the time of our inspection in April 2019, fell below local and national averages. However, improvements to performance for one diabetes indicator and the hypertension indicator were now required.
• The limited access for people with mobility issues and lack of an accessible patient toilet at the branch surgery remained and had not been effectively managed in a timely manner.
• Improvements to clinical audit activity was now driving quality improvement to patient care.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure all premises and equipment used by the service provider is fit for use.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Continue to monitor and improve national GP patient survey patient satisfaction scores.

As our inspection on 3 and 4 December 2019 found that the provider had not fully met the Requirement Notices issued after the April 2019 inspection, we imposed conditions on Wigmore Medical Centre’s registration with the Care Quality Commission. The conditions were:

• The registered provider must not carry on any regulated activities at the branch surgery at Hempstead Medical Centre, 144 Hempstead Road, Hempstead, Gillingham, Kent, ME7 3QE without the prior consent of the CQC and until such time as the following actions have been carried out at the branch surgery at Hempstead Medical Centre, 144 Hempstead Road, Hempstead, Gillingham, Kent, ME7 3QE:

• A fire risk assessment is carried out at the branch surgery at Hempstead Medical Centre, 144 Hempstead Road, Hempstead, Gillingham, Kent, ME7 3QE by a relevantly qualified organisation external to the practice and action has been taken in response to all findings of the fire risk assessment;

• Reasonable adjustments are carried out at the branch surgery at Hempstead Medical Centre, 144 Hempstead Road, Hempstead, Gillingham, Kent, ME7 3QE to ensure that the premises comply with The Equality Act 2010.

• A patient accessible toilet is installed at the branch surgery at Hempstead Medical Centre, 144 Hempstead Road, Hempstead, Gillingham, Kent, ME7 3QE.

This service was placed in special measures in April 2019. Although improvements have been made these are insufficient such that there remains a rating of inadequate for responsive and all patient population groups. I am placing the service into special measures for a further six months.

Services placed into special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service.

Special measures will give people who use the service the reassurance that the care they get should improve.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and the evidence tables for further information.

This practice is rated as Inadequate overall.

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at Wigmore Medical Centre on 2, 3 and 8 April 2019 under Section 60 of the Health and Social Care Act 2008, as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• An effective system for reporting and recording significant events had been introduced in March 2019.
• The practice learned and made improvements when things went wrong.
• The practice’s systems, processes and practices did not always help to keep people safe.
• Risks to patients, staff and visitors were not always assessed, monitored and managed in an effective manner. For example, in relation to the arrangements for managing medicines as well as infection prevention and control.
• Staff had the information they needed to deliver safe care and treatment to patients.
• Published results showed the childhood immunisation uptake rates for the vaccines given were lower than the minimum target percentage of 90% in one other of the four indicators.
• Published QOF data from 2017 / 2018 showed that the practice’s exception reporting for some indicators was higher than local and national averages. However, unverified data demonstrated that the practice had taken action and exception reporting to date in the current period being measured had been greatly reduced.
• Staff had the skills, knowledge and experience to carry out their roles. However, not all staff were up to date with essential training.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.
• Where national GP patient survey results were below average the practice was taking action to address some of the findings and improve patient satisfaction.
• There were clear responsibilities, roles and systems of accountability to support good governance and management. However, governance arrangements were not always effective.
• The limited access for people with mobility issues and lack of an accessible patient toilet at the branch surgery had not been effectively managed in a timely manner.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure all premises and equipment used by the service provider is fit for use.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

• Continue to monitor and improve national GP patient survey patient satisfaction scores.
• Continue with plans to install a hearing loop at the branch surgery.
• Continue to identify patients who are also carers to help ensure they are offered appropriate support.

I am placing the service in special measures. Services placed in special measures will be inspected again in 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.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service reassurance that the care they get should improve.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and the evidence tables for further information.