The Care Quality Commission
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Archived: Lowther Medical Centre

Overall: Good read more about inspection ratings

1 Castle Meadows, Whitehaven, Cumbria, CA28 7RG (01946) 692241

Provided and run by:
Lowther Medical Centre

Important: The provider of this service changed. See new profile

All Inspections

2nd November 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection March 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Lowther Medical Centre on 2 November 2017 as part of our inspection programme.

At this inspection we found:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

  • Risks to patients were assessed and generally well-managed, although some risk assessments and policies were overdue for review.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

  • Review risk assessments and policies which are due for renewal and update them as required.

  • Make sure documentation for Patient Group Directions and Patient Specific Directions is signed as directed.

  • Continue to monitor and improve access to appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

31/03/2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a previous announced inspection of this practice on 4 August 2015. Breaches of legal requirements were found. Overall, we rated the practice as inadequate.

After the comprehensive inspection the practice wrote to us to say what they would do to address four identified breaches of regulation. The practice underwent a focused inspection on 27 January 2016 to check whether the provider had taken steps to comply with the legal requirements for three of the four breaches (The date by which the provider had to comply with legal requirements for the fourth warning notice had not been reached at the time of that inspection). It was found that improvements had been made.

We undertook this comprehensive inspection on 31 March 2016 to check that the practice had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection and our focused inspection by selecting the ‘all reports’ link for Lowther Medical Centre on our website at www.cqc.org.uk.

Overall the practice is rated as good.

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

  • The practice had taken action to address the concerns raised at the comprehensive CQC inspection in August 2015. They had developed a clear vision, strategy and plan to deliver high quality care and promote good outcomes for patients.
  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Continue to monitor and seek methods of improving patient access to the practice, both in terms of access by telephone and access to appointments.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

27 January 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced, comprehensive inspection of this practice on 4 August 2015. Breaches of legal requirements were found. Although the provider was not required to submit an action plan following the publication of our report of that inspection, they did tell us about the improvements they intended to make to address the breaches of legal requirements, as set out in the Health and Social Care Act (HSCA) 2008. The provider had sent us their updated plan on a weekly basis following the inspection in August 2015.

We identified breaches of four regulations when we carried out the inspection on 4 August 2015 and a warning notice was issued for each breach. This focused inspection on 27 January 2016 was to check whether the provider had taken steps to comply with the legal requirements for three of these four breaches of regulation (The date by which the provider has to comply with legal requirements for the fourth warning notice had not been reached at the time of this inspection). The three breaches of regulation we inspected against were for:

  • Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment

  • Regulation 18 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Staffing

  • Regulation 19 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Fit and proper persons employed

This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Lowther Medical Centre on our website at www.cqc.org.uk

Our key findings were as follows:

  • Improvements to patient safety had been made following our last inspection on 4 August 2015. For example, action had been taken to improve the arrangements for assessing the risk of, and controlling and preventing the spread of infection. Suitable arrangements had been made for the safe handling of prescriptions. There was a more effective system for monitoring the temperatures of refrigerators used for the storage of temperature sensitive medicines and vaccines.

  • Staff had completed training on a wide range of subjects since the last inspection. This included on infection control, health and safety, information governance, safeguarding adults and chaperoning.

  • Progress had been made on providing staff with appraisals. Responsibility for appraising staff had been delegated to key staff and they had been provided with training to be able to appraise staff effectively.

  • All staff had been the subject of a Disclosure and Barring Service (DBS) check.

  • A number of staff had been recruited since the last inspection. We found the provider had followed their recruitment policy and completed the required pre-employment checks for these staff. This included completing checks of identity, DBS checks and seeking references from previous employers.

However there was one area where the provider should make improvements:

The provider should:

  • Ensure that the timetable for the appraisal of staff is delivered as planned. The provider should continue to update the Care Quality Commission on progress with this in line with the current arrangements.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

4 August 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

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

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

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate checks on staff had not been undertaken prior to their employment. Actions identified to address concerns with infection control arrangements had not been taken. The systems in place for the management of medicines were not safe. Health and safety risk assessments had not been completed.
  • Staff were not clear about the systems in place for the dissemination of safety alerts and the latest guidance.
  • There was insufficient assurance to demonstrate the practice were managing, monitoring and improving outcomes for patients through the use of effective clinical audit. None of the audits we were presented with had been through two complete audit cycles to be able to demonstrate improved outcomes for patients.
  • The majority of staff had not completed the mandatory training required, as specified by the practice, as being applicable to their roles.
  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
  • Patients said they felt involved in decisions made about their care and treatment.
  • 91.4% of people experiencing poor mental health had agreed care plans in place.
  • The practice employed an elderly care co-ordinator who had helped to identify the need for clinical interventions that may have been missed due to patients not attending the practice. For example, 96 healthcare referrals had been made between May 2014 and April 2015 and 67 medicines referrals had been made over the same period for patients prescribed five or more medicines to have these reviewed.
  • Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments and that it was very difficult to get through to the practice when telephoning to make an appointment.
  • The practice had limited formal governance arrangements.

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

The areas where the provider must make improvements are:

  • Take action to ensure care and treatment is provided in a safe way for service users through the proper and safe management of medicines.
  • Put effective systems in place to manage and monitor the prevention and control of infection. This must include putting in place and adhering to policies that will help to prevent and control infections.
  • Put in place systems or processes which must be established and operated effectively in order to demonstrate good governance.
  • Ensure that staff receive appropriate support, training, professional development, supervision and appraisal to enable them to carry out the duties they are employed to do.
  • Ensure that recruitment information is available for each person employed. This includes completing Disclosure and Barring Service (DBS) checks for those staff who need them, proof of identity and references.
  • Ensure that staff employed are registered with the relevant professional bodies where such registration is required.

In addition the provider should:

  • Review the arrangements in place for the recording of patient’s consent to ensure that all staff are applying this consistently and in line with legal requirements.

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 vary the provider’s registration 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