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The Matthews Practice Belgrave Requires improvement

Reports


Inspection carried out on 9 January 2019

During a routine inspection

We carried out an announced comprehensive inspection at the Mathews Practice Belgrave on 16 March 2018. The practice was rated as requires improvement overall and was to remain in Special Measures until further improvements had been seen.

At our inspection on 16 March 2018 we found:

  • The practice was in the process of implementing a complex process of change management in order to make improvements and develop their service.
  • The practice had undergone a number of recent and significant changes to their senior management team. For example, GP partnership arrangements had changed because one of the GP partners had stepped down to become a salaried GP and a new Registered Manager had recently been appointed.
  • Practice governance arrangements needed to be fully embedded to ensure lasting and positive changes could be sustained within the practice.
  • Quality Outcomes Framework (QOF) data available on the day of inspection identified that the practice was failing in delivering adequate plans and pathways to mitigate risks and thoroughly risk assess the management of long term conditions. Subsequent QOF data from 2017/18 showed some improvement whereby the practice achieved 519.54 out of 559 points.

Requirement notices were issued because:

  • Patient Group Directives (PGD’s) needed attention to ensure that they were being managed correctly.
  • A number of confidential patient records were being held in an area used for occasional external visitor meetings. Although these records were stored behind a security coded door we found some of the drawers to be unlocked on the day of inspection.
  • The practice had a sepsis strategy in place however on the day of inspection a member non-clinical staff we spoke to was not aware of the management of sepsis should a patient present with symptoms.

This inspection, was an announced comprehensive inspection, which was carried out on 9 January 2019. This report covers our findings in relation to the practice meeting the requirements of the requirement notices and also additional improvements made since our last inspection.

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 on-going monitoring of data about services.
  • Information from the provider, patients, the public and other organisations.

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

We found that:

  • The practice had worked through a substantial process of change management in order to make improvements and develop their service in collaboration with the local Clinical Commissioning Group (CCG) and the Royal College of General Practitioners (RCGP).
  • The practice had undergone a number of recent and significant leadership changes and was nine days into a new contract as a single handed provider.
  • New practice governance arrangements had been implemented to develop lasting and positive changes within the practice.
  • Quality outcomes framework data available on the day of inspection identified that the practice was delivering plans and pathways to mitigate risks and assess the management of long term conditions.

  • A new policy and process was in place to ensure that Patient Group Directives (PGD’s) were being managed correctly.
  • Confidential patient records were being safely stored behind a security coded door.
  • The practice had a sepsis strategy in place and all staff that we spoke to were aware of the management of sepsis should a patient present with symptoms.
  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect.
  • The practice organised and delivered services to meet patients’ needs.
  • The way the practice was managed promoted the delivery of quality care.

Whilst we found no breaches of regulations, the provider

should

:

  • Improve the cascade and management of safety alerts.
  • Amend their staff vaccination protocol to include Varicella (chicken pox) and MMR (measles, mumps and rubella) in order to be in accordance with current Public Health England (PHE) guidance.
  • Improve patient access to services.
  • Review and improve patient satisfaction with regard to their involvement in decisions about their care and treatment and their access to appointments.

This practice had met the requirement notices issued in March 2018 and has been taken out of special measures.

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

Professor Steve Field

CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection carried out on 16 March 2018

During a routine inspection

This practice is rated as Requires Improvement overall and will remain in Special Measures until further improvements have been seen.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people living with dementia) - Requires Improvement

We carried out an announced comprehensive inspection at the Mathews Practice on 24 July 2017. The overall rating for the practice was inadequate, warning notices were issued, and the practice was placed into special measures. An announced focused inspection was carried out on 12 February 2018 which confirmed that the practice had met the requirements of the warning notices issued in July 2017.

This was an announced comprehensive inspection which was carried out on 16 March 2018. This report covers our findings in relation to the practice meeting the requirements of the requirement notices and also additional improvements made since our last inspection.

At this inspection we found:

  • The practice was in the process of implementing a complex process of change management in order to make improvements and develop their service.

  • The practice have undergone a number of recent and significant changes to their senior management team. For example, GP partnership arrangements had changed because one of the GP partners had stepped down to become a salaried GP and a new Registered Manager had recently been appointed.

  • Practice governance arrangements needed to be fully embedded to ensure lasting and positive changes could be sustained within the practice.

  • Practice staff needed to contribute to the development and effective implementation of the new practice vision.

  • The practice had begun to implement systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, we saw evidence that the practice were learning from them.

  • The practice had started to review the effectiveness and appropriateness of the care it provided however data relating to the management of long term conditions was significantly lower than CCG and national averages.

  • Staff treated patients with kindness and respect.

  • Most patients found the appointment system easy to use and reported that they were able to access care when they needed it.

  • There was an improved focus on learning and development across the organisation.

  • The practice had taken steps to improve their achievement of the Quality Outcomes Framework (QOF is a voluntary annual reward and incentive programme for all GP surgeries in England, detailing practice achievement results and then rewarding good practice). 

The areas where the provider must make improvements are:

  • The practice had a sepsis strategy in place however on the day of inspection a member non-clinical staff we spoke to was not aware of the management of sepsis should a patient present with symptoms.

  • Quality outcomes framework data available on the day of inspection identified that the practice was failing in delivering adequate plans and pathways to mitigate risks and thoroughly risk assess the management of long term conditions.  Subsequent QOF data from 2017/18 shows some improvement whereby the practice achieved 519.54 out of 559 points.

  • Patient Group Directives (PGD’s) (needed attention to ensure that they were being managed correctly. For example, some documentation was difficult to find because it had been incorrectly filed.

  • A number of confidential patient records were being held in an area used for occasional external visitor meetings.  Although these records were stored behind a security coded door we found some of the drawers to be unlocked on the day of inspection.

The areas where the provider should make improvements are:

  • The practice had oversight of vulnerable patients and they were discussed at Multi-Disciplinary team meetings however they did not hold dedicated palliative care meetings.

  • The branch surgery premises needed attention to improve the general condition of the building and we did not see any plans to address this issue.

  • The practice needed to focus on patient access to ensure that the local population are able to gain appointments when necessary.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 12 February 2018

During a routine inspection

We carried out an announced comprehensive inspection at the Mathews Practice on 24 July 2017. The overall rating for the practice was inadequate and the practice was placed in to special measures. The full comprehensive report on the 24 July 2017 inspection can be found by selecting the ‘all reports’ link for The Mathews Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 February 2018 to confirm that the practice had met the requirements of the warning notices which were issued following the inspection on 24 July 2017. This report covers our findings in relation to the practice meeting the requirements of the warning notices and also additional improvements made since our last inspection.

Our key findings were as follows:

  • Staff were using up to date protocols and policies to assist them in their work.

  • The practice had plans in place to address reported poor telephone access.

  • QOF (the Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England, detailing practice achievement results) achievement had been under reviewed and had been improved.

  • Long-term condition management had been under reviewed and had been

      improved.

  • All practice staff had been appraised and had access to relevant continuing professional development.

  • Chaperone notices were clearly visible to patients in consultation and treatment rooms.  Staff who acted as chaperones were documenting that they had provided chaperoning duties in the patient record.  (a chaperone is a person who serves as a witness for both a patient and a medical professional as a safeguard for both parties during an intimate medical examination or procedure).

  • Most staff felt engaged with how the practice was run.

  • Patients that we spoke to felt engaged with how the practice was run.

  • The practice were keeping a record of complaints which included the investigations undertaken as a result of complaints received.  Learning from complaints was shared with practice staff to prevent recurrence and improve future performance.

Importantly, the provider should:

  • Review and update the practice registration details to ensure that the service is correctly registered and to notify the Care Quality Commission that this has taken place within four weeks of this inspection.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 24 July 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Mathews Practice Belgrave on 1 November 2016. The overall rating for the practice was inadequate and the practice was placed into special measures for a period of six months. The full comprehensive report for the November 2016 inspection can be found by selecting the ‘all reports’ link for the Mathews practice on our website at www.cqc.org.uk.

As a result of the inspection on 1 November 2016 warning notices were served. The practice was re-inspected on 6 June 2017 to follow up on the warning notices and found to have completed the requirements of the notice.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection.

We found that the practice had made some improvement when we carried out the comprehensive inspection on 24 July 2017.  However overall the practice is still rated as inadequate.

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

  • Some staff were beginning to understand their responsibilities to raise concerns and to report incidents and near misses.
  • Some risks to patients were being assessed.
  • Information about how to complain was available and some lessons were being learned however the practice did not keep details of the investigations that were undertaken as a result of complaints.
  • Some patients said they were treated with compassion, dignity and respect.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Ensure specified information is available regarding each person employed.
  • Establish effective governance systems and management processes in accordance with the fundamental standards of care to improve patient access to quality services.
  • Establish effective governance systems and management processes to ensure that: patients are kept safe in relation to: emergency guidance, patient confidentiality and improved communication with staff through significant event reporting.

The areas where the provider should make improvements are:

  • Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences​.

This service was placed in special measures in November 2016. Insufficient improvements have been made such that the overall rating for The Mathews practice remains inadequate and the service will remain in special measures. Therefore we are taking action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This

which 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 four months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field

CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 6 June 2017

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Matthews Practice Belgrave on 1 November 2016. The overall rating for the practice was inadequate 

and the practice was placed in special measures for a period of six months.

 The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for 'The Matthews Practice Belgrave' on our website at www.cqc.org.uk.

This inspection was an announced focused inspection

 carried out on 6 June 2017 to follow up the earlier inspection on 1 November 2016.

Breaches of legal requirements were found in relation the governance arrangements in the practice and for providing safe care and treatment. We issued the practice with warning notices under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for Regulation 12, Safe Care and Treatment and Regulation 17, Good Governance. During our November 2016 inspection we found that the provider did not have effective governance processes and systems to provide safe care and treatment to patients.

We undertook this focused inspection on 6 June 2017 to check that the practice had addressed the issues in the warning notices and now met the legal requirements. This report only covers our findings in relation to those requirements and will not change the ratings.

At the inspection, we found that the requirements of the warning notices had been met.

Our key findings across the areas we inspected for this focused inspection were as follows:

  • The provider had reviewed the system for reporting and recording significant events and implemented a significant event policy. Staff were aware of the new process and told us they would inform the practice manager of any incidents and there was a recording form available on the practice’s computer system.

  • The provider had reviewed arrangements for safeguarding to reflect relevant legislation and local requirements. The lead member of staff for safeguarding had appropriate permissions within the patient records system to access safeguarding alerts and staff had undertaken safeguarding training updates relevant to their role.

  • The provider had reviewed the cleanliness and hygiene arrangements at the White Lane branch surgery since our last inspection. We observed the premises to be clean and tidy. There were cleaning schedules and monitoring systems in place. Cleaning equipment and substances hazardous to health were now appropriately stored. Action had been taken to refurbish parts of the premises. 
  • An annual infection prevention and control audit had been undertaken at both sites and action taken in accord with the findings.
  • The provider had reviewed their procedures for assessing, monitoring and managing risks to patient and staff safety. A fire risk assessment had been undertaken at both sites and fire evacuation drills had been completed.
  • The GP locum pack had been updated to include relevant information they may need.
  • The provider had reviewed the overarching governance framework to support safe care and treatment and provide good quality care. Staff told us this was in the process of being rolled out across the two sites.
  • The GPs, pharmacist and clinical staff had reviewed the audits undertaken and developed a new plan to monitor outcomes for patients and to make improvements.
  • Two full practice meetings had been held since our last inspection which provided an opportunity for staff to learn about the performance of the practice. A new meeting structure had been recently implemented where a staff representatives from each group would attend a monthly meeting with the practice manager.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection carried out on 1 November 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Matthews Practice on

1 November 2016

.

Overall the practice is rated as inadequate.

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

  • Staff could describe the practice incident reporting process, however there was no evidence staff other than the GPs and practice manager reported incidents, near misses and concerns. Although the practice carried out investigations when there were unintended or unexpected safety incidents, investigations were not documented thoroughly, lessons learned were not communicated widely therefore safety was not improved.
  • Some risks to patients were assessed and managed. Others required immediate review particularly those relating to infection prevention and control, safeguarding training updates for staff and processes for standards of cleanliness and hygiene at both the main and branch sites and the fire risk assessments.

  • Data showed patient outcomes were low compared to the national average. Although some audits had been carried out, we saw little evidence that audits were driving improvement to patient outcomes.
  • The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.

  • Information about services was accessible and available to all patients. For example, there was a Chinese speaking member of staff and information leaflets were available in Chinese due to the large number of Chinese speaking patients on the practice list.
  • The practice had a number of policies and procedures to govern activity, but some were incomplete or missing.

The areas where the provider must make improvements are: 

  • Ensure that policies and procedures are available to staff are updated accordingly.
  • Ensure all staff have the appropriate permissions within the patient electronic record system to allow access to appropriate information relating to their role.
  • Ensure an infection prevention and control audit is undertaken at both sites and immediate actions taken in accord with the findings.
  • Ensure all staff have access and undertake appropriate training for their role and receive updates as required.
  • Track prescriptions through the practice in accordance with NHS Protect Security of prescription guidance (2013).
  • Ensure actions identified as a result of any risk assessments undertaken are documented and completed. For example, the fire risk assessment, control of substances hazardous to health and the short to mid term business action plan.
  • Review the systems in place to ensure the availability of appropriate emergency medicines at the sites where minor surgery is performed.

In addition the provider should: 

  • Document actions taken as a result of current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines.
  • Review the GP locum pack to include relevant information to support GP locums working at the practice.

  • Continue with the review of telephone access to the practice and establish a solution to improve access for patients.

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.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice