Archived: Meir Park Surgery

We previously carried out an announced comprehensive inspection at Meir Park Surgery on 6 March 2019 as part of our inspection programme. The practice was rated inadequate, placed into special measures and a warning notice in relation to safe care and treatment was issued. We carried out an announced focused inspection at Meir Park Surgery on 30 April 2019 to ensure that the issues identified in the warning notice had been addressed. The full comprehensive reports on the inspections carried out in March and April 2019 can be found by selecting the ‘all reports’ link for Meir Park Surgery on our website at www.cqc.org.uk 

We carried out an announced comprehensive inspection at Meir Park Surgery on 16 September 2019. At this inspection we followed up on breaches of regulations identified at a previous inspection on 6 March 2019.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected.
• information from our ongoing monitoring of data about services.
• information from the provider, patients and other organisations.

We have rated this practice as requires improvement overall.

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

• Staff had completed the appropriate levels of safeguarding children and vulnerable adult training. Staff who acted as chaperones were trained for the role.
• A system to follow up children and young people with a high number of accident and emergency attendance or children who failed to attend hospital appointments had been introduced.
• The management of safety systems was not always effective particularly in relation to managing health and safety risks, monitoring the use of prescriptions, recording recruitment information and ensuring new registered patient electronic records were up to date.
• The practice did not routinely discuss vulnerable patients with either external agencies or internally within the staff team.
• Although staff training on how to identify deteriorating or acutely unwell patients had been provided, the knowledge and learning was not fully embedded.
• The practice had not embedded a system to ensure that patients on high risk medicines remained up to date with their blood monitoring, and medicine review dates were amended prior to annual blood tests being completed for patients on lower risk medicines.
• Significant events were discussed and learning shared with the nursing and administration team, although it was not clear if this was taking place within the clinical staff team.

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

• The practice had introduced a system to monitor staff compliance with essential training, and staff were up to date with this training.
• Patients’ needs were assessed, and care and treatment delivered in line with current legislation.
• There was a lack of evidence of a timely action plan following an audit where there were identified areas for improvement to mitigate patient risk.
• The uptake of cervical screening was below the national target.

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

• The practice had acted on feedback from patients and introduced a new telephone system with one number for both sites, which included notifying patients of their position in the queue.
• Patients could book and attend appointments with any clinician at either site.
• Although the results of the National GP survey had improved in relation to patient satisfaction around access, the results remained below the national average.
• Learning from complaints was shared with nursing and non-clinical staff through staff meetings. There was a lack of evidence to demonstrate GP engagement at these meetings.

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

• While the practice had made some improvements since our inspection on 6 March 2019, there remained differences in the ways of working across the two sites.
• The practice had developed a three-year business development plan and was working with external agencies to bring about the changes required to improve the quality of the service.
• Nursing and reception /administrative staff told us they valued the monthly practice meetings. The meetings gave them the opportunity to discuss any issues and raise any concerns with business manager and practice manager. They felt that their views were being listened to and taken forward where possible.
• The practice had systems in place for identifying, managing and mitigating risks, although these needed to be strengthened and embedded.

These areas affected all population groups so we rated all population groups as requires improvement.

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

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Ensure that the training provided to staff on identifying deteriorating or acutely unwell patients had been provided is fully embedded and staff ware able to describe what symptoms to be aware of.
• Continue to try and establish safeguarding meetings with other agencies.
• Implement measures to improve privacy at the reception desk.
• Implement a system which includes the documentation of patients verbal comments/complaints.
• Implement measures to improve the uptake of cervical cancer screening.
• Implement a formal system for competency reviews of specialist clinical staff.
• Complete in-house patient survey as planned.
• Implement measure to improve the uptake of cervical cancer screening.

I am taking this service out of special measures. This recognises the improvements made to the quality of care provided by the service.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated

We previously carried out an announced comprehensive inspection at Meir Park Surgery on 6 March 2019 as part of our inspection programme. The practice was rated inadequate, placed into special measures and a warning notice in relation to safe care and treatment was issued. The full comprehensive report on the March 2019 inspection can be found by selecting the ‘all reports’ link for Meir Park Surgery on our website at .

We carried out an announced focused inspection at Meir Park Surgery on 30 April 2019 to ensure that the issues identified in the warning notice had been addressed. This report only covers our findings in relation to the warning notice.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected.
• information from our ongoing monitoring of data about services.
• information from the provider, patients and other organisations.

We found that:

• Suggested emergency medicines were available at the branch practice.
• Medicines and Healthcare products Regulatory Agency (MHRA) alerts were acted upon.
• Clinical and non-clinical staff had completed the appropriate level of safeguarding children and vulnerable adults training for their roles.
• Non-clinical staff were trained in identifying deteriorating or acutely unwell patients suffering from potential illnesses such a sepsis.
• All staff who acted as chaperones were trained for this role.
• Staff who acted as fire marshals had received the required training.
• All staff had received training on infection prevention and control.
• The practice had arrangements for following up failed attendance of children’s appointments following an appointment in secondary care or children who were frequent A&E attenders.
• Patients potentially in the pre-diabetic stage had been coded appropriately within the practice’s computer system and received appropriate life-style advise.
• There had been improvements in recruitment checks however, health assessments were not always completed.
• The practice had processes for monitoring patients prescribed high risk medicines however, they needed to consider alternative ways to promote patient compliance with blood test monitoring.
• Children’s safeguarding meetings with other agencies had not been held.
• A system of reconciling children at risk of harm, as identified by the practice, with health visitors and school nurses was not in place.

At this inspection, we found that the provider had satisfactorily addressed most of the issues identified in the warning notice. However, there were areas where the provider remains in breach and must make improvements that we will follow up at our next inspection:

• Complete risk assessments for staff who have not received a health assessment.
• Implement systems to promote patient compliance with required blood test monitoring.
• Establish safeguarding meetings with other agencies.
• Reconcile the practice’s list of children at risk of harm with appropriate agencies.

Details of our findings and the supporting evidence are set out in the evidence table.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care.

We carried out an announced comprehensive inspection at Meir Park Surgery on 6 March 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall and requires improvement for all population groups.

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

• Staff had not been made aware of the most up to date safeguarding policies and procedures to refer to or where to locate them.
• Some clinical and non-clinical staff had not completed safeguarding training appropriate to their role. Not all staff who acted as chaperones were trained for this role.
• Regular safeguarding meetings with other agencies had not been held and a system of reconciling children at risk of harm identified by the practice with health visitors and school nurses was not in place. The practice did not have arrangements for following up failed attendance of children’s appointments following an appointment in secondary care or frequent A&E attendances.
• Recruitment checks had not always been carried out in accordance with regulations.
• Two members of staff who acted as fire marshals had not received the required training. Not all staff had received training on infection prevention and control. Non-clinical staff had not been provided with training to make them aware of possible signs of sepsis.
• Not all the suggested emergency medicines were available at the branch practice. A risk assessment to mitigate potential risks to patients had not been completed. The process for monitoring patients prescribed high risk medicines was not always effective. Appropriate monitoring and clinical review prior to prescribing was not always completed.
• Medicines and Healthcare products Regulatory Agency (MHRA) alerts were not always acted upon.
• A system for sharing learning from significant events with staff was not in place.

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

• Patients’ needs were assessed, and care and treatment were delivered in line with current legislation.
• The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided.

However:

• We identified 248 patients in the potentially pre-diabetic stage who had not been coded appropriately within the practice’s computer system or received life style advise.
• The practice did not have arrangements for following up failed attendance of children’s appointments following an appointment in secondary care.
• There were multiple gaps in staff training in relation to equality and diversity, basic life support, fire safety, mental capacity act, health and safety and safeguarding vulnerable adults and children.

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

• Staff treated patients with kindness, respect and compassion.
• The practice respected patients’ privacy and dignity.

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

• Patient satisfaction with access to appointments was significantly below the national average.
• A system was not in place to follow up children and young people with a high number of accident and emergency attendances or children who failed to attend hospital appointments.
• There was no system in place to share learning from complaints with staff across both sites.

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

• Action plans to address the challenges faced by the practice were not in place. This included succession planning and delivery of the service in relation to very low patient satisfaction with access to appointments.
• Staff were not aware of the practice’s vision.
• There were very low levels of staff satisfaction and high levels of stress across both practices. Staff did not feel that their views were listened to or valued.
• Staff were confused regarding where they would locate the most up to date policies.
• An overarching system to monitor staff compliance with essential training was not in place.
• A system of sharing learning from significant events and complaints with staff was not in place.
• Five of the eight recommendations we made at our previous inspection had not been fully implemented.

The provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

The provider should:

• Improve access to interpretation services at the main practice.
• Identify ways of improving access to appointments.
• Record in patients’ notes that blood test results have been checked by a GP and are within a safe therapeutic stage before issuing repeat prescriptions for methotrexate.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

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 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 the reassurance that the care they get should improve.

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care