Archived: Church Lane Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Church Lane Medical Centre on 4 June 2015. Overall the practice is rated as inadequate.

We found the practice inadequate for providing safe, effective, caring, responsive and well-led services. It was also inadequate for providing services for the six population groups. These are, people with long term conditions, families, children and young people, working age people, older people, people in vulnerable groups and people experiencing poor mental health. This is because the concerns which led to these ratings apply to everyone using the practice, including all of the population groups.

Our key findings were as follows

• Patients were at risk of harm because systems and processes were not in place to keep them safe. Recruitment checks and safeguarding procedures were not robust. Risks such as fire and legionella had not been assessed and managed.

• The arrangements in place to identify, review and monitor patients with some long term conditions and at risk groups were not effective. The most recent national data for the year 2013-2014 showed the practice was below the national average for areas such as depression assessments and the management of hypertension (high blood pressure). The practices detection rates for cancer and identification rates for chronic obstructive pulmonary disease (COPD) (lung disease) was also below the national average.

• Patients told us they felt listened to and supported by staff. However, confidentiality was not always maintained in the patient waiting area and there were examples of staff not treating patients in a respectful and considerate manner.

• Patients reported that appointments were not easily accessible and this was aligned with results from the most recent national GP survey 2014-2015. The complaints procedure was not easily accessible to patients.

• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements. The practice had not proactively sought feedback from staff or patients and did not have a patient participation group (PPG). Staff told us they had not received regular training, performance reviews and did not have clear objectives.

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

Importantly, the provider must:

• Have effective systems in place for the management of risks to patients and others against inappropriate or unsafe care. This must include establishing robust recruitment processes, adherence to infection prevention and control procedures and completion of risks assessments in areas such as fire and legionella.

• Develop a systematic, proactive approach to identifying and targeting health promotion and preventative care services for patients who would benefit from them. The practice must use national data to assess its performance and to monitor and improve outcomes for patients.

• Ensure that staff have clearly defined roles and responsibilities with appropriate support, training and supervision to ensure they are working within their competencies.
• Establish robust systems for the management and handling of complaints and make information on raising complaints easily accessible to patients and others.

• Ensure robust governance arrangements are in place to assess and monitor the quality of services provided. Ensure audits complete their full cycle in order to demonstrate improvements made to patient outcomes.

• Seek and act on feedback from patients, staff and others to improve the quality of the service provided.

Action the provider should take :

• Ensure patients are always treated in a respectful manner and there are arrangements for patients to discuss issues in private with reception staff.

On the basis of the ratings given to this practice at this inspection, and the concerns identified I am 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