The service is rated as Inadequate overall.
We carried out an announced comprehensive inspection at Sandy Health Centre Medical Practice on 3 February 2020 following our annual regulatory review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.
Our inspection team was led by a CQC inspector and included a GP specialist advisor and practice nurse specialist advisor.
At the last inspection in June 2016 we rated the practice as good overall.
Our judgement of the quality of care at this service is based 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.
The practice is rated as Inadequate overall.
We rated the practice as inadequate for providing safe services because:
- The process for managing medicines that required additional monitoring was lacking and not all blood testing was completed prior to prescribing.
- There was no formal system in place to assess the risk of dispensing acute medicines before the prescription was signed by a clinician. Shortly following the inspection, the practice told us that a formal protocol had been put in place.
- The systems for infection prevention and control were lacking and there was no evidence of cleaning that was completed.
- Patient Specific Directions (PSDs) to authorise non-prescribing clinical staff to administer injections such as flu vaccinations, were not in place. Following the inspection, the practice told us they had reviewed this system.
- The practice could not provide evidence that all staff had completed fire training and did not complete regular fire drills.
- The practice did not hold evidence of recruitment checks, training or revalidation for locum staff.
We rated the practice as requires improvement for providing effective services because:
- Records we looked at showed that not all patients with atrial fibrillation were prescribed anticoagulation and the clinical records did not show a clear rationale for this.
- There was limited oversight of training and the practice could not provide evidence that all staff had completed the mandatory training detailed in the practice policy.
- The competency assessments for nursing staff was lacking and there was no audit of consultation or prescribing of advances clinical staff.
We rated the practice as requires improvement for providing caring services because:
- Caring indicators within the GP Patient Survey were below local and national averages. The practice was unaware of this and had not created an action plan to address these issues.
- The practice did not hold materials for those with differing communication needs such as those with a learning disability.
We rated the practice as requires improvement for providing responsive services because:
- The GP patient survey scores relating to telephone access were significantly below local and national averages. The practice was unaware of these and had not created an action plan to address this.
- Patients told us it was difficult to access the practice via the telephone and many patients chose to attend the practice in person at 8am or use walk-in clinics.
- Response letters to complaints did not include details of how to escalate concerns to the Parliamentary and Health Service Ombudsman. Following the inspection, the practice told us they had addressed this.
We rated the practice as inadequate for providing well-led services because:
- There was a lack of oversight regarding medicines that required additional monitoring, prescription safety and PSD’s.
- The practice was unaware of the GP Patient survey results and did not have an action plan in place to address lower that average indicators.
- The practice was unaware of the higher than average hypnotic prescribing.
- Not all staff had received an appraisal in the last twelve months.
- There was limited evidence that the practice acted on patient views to shape the service provided.
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.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BS BM BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care