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Archived: South Ashford Medics Inadequate

Reports


Inspection carried out on 20 March 2018

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

This practice is rated as inadequate overall.

On 20 March 2018 we carried out a follow up inspection to check compliance with two enforcement notices issued in respect of the care and treatment of patients and good governance. The notices were issued following our initial inspection of South Ashford Medics on 5 December 2017. The practice was placed into special measures in February 2018, to be reinspected and re rated again within six months.

At this inspection we checked South Ashford Medics had complied with the notices issued in respect of safe care and treatment and had partially complied with the notice issued in respect of good governance. Therefore, further improvements were required.

At this inspection we found:

  • The GP partners had undertaken practical annual basic life support training.
  • The practice had appropriately coded patients to inform their prescribing behaviours.
  • The practice had established systems in place to ensure the safe management of medicines. For example, the timely actioning of safety alerts.
  • The practice had put an action plan in place with their patient participation group to improve patient experiences of the service.
  • The practice had revised their complaints and identified trends and learning themes.
  • Meetings had been held with teams to advise them of their whistleblowing procedure and staff members they may go to should they have concerns.
  • The practice pneumococcal vaccination figures had improved and they had achieved 91% immunisation rate for children under two years of age.
  • The practice had revised their safeguarding systems but the changes had not been embedded and risks were not being followed up on.
  • The practice had not revised their palliative care register to ensure discussions or decisions relating to resuscitation preferences were evidenced.
  • The practice histology system was not reflective of minor surgery procedures undertaken. Where errors had occurred they were not reported and investigated to mitigate a reoccurrence.
  • Staff performing workflow optimisation activities had not received documented training or audited their staffs work to assure themselves the system was safe and effective.

The area where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 is 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 provides people who use the service with the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 5 December 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as inadequate overall.

The key questions are rated as:

Are services safe? – inadequate

Are services effective? – requires improvement

Are services caring? – requires improvement

Are services responsive? – inadequate

Are services well-led? - inadequate

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 – inadequate

People with long-term conditions – inadequate

Families, children and young people – inadequate

Working age people (including those recently retired and students – inadequate

People whose circumstances may make them vulnerable – inadequate

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

We carried out an announced comprehensive inspection at South Ashford Medics on 5 December 2017 as part of our inspection programme.

At this inspection we found:

  • The practice had insufficient systems in place to keep patients safe. For example, delays and inconsistencies in the reviewing and actioning of information.
  • They did not ensure the safe management of medicines. For example, the consistent actioning of safety alerts and tracking of prescriptions.
  • Some clinical staff had not received safeguarding or basic life support training.
  • We found the practice to be clean and tidy and an annual infection control audit had been conducted.
  • The practice achieved 98% of the Quality and Outcome Framework points available.
  • The practice recorded, investigated and responded to complaints but did not consistently capture learning to improve the practice.
  • Some of the respondents to the July 2017 GP patient survey reported their experience of the GPs to be below the local and national averages.
  • The practice held regular governance meetings but had failed to identify risks and mitigate them.
  • The GP partners did not operate as a cohesive team. The GP partners concentrated their activities in areas of clinical preference as opposed to ensuring the delivery of safe consistent care.

The areas where the provider must make improvements are:

  • 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 areas where the provider should make improvements are:

  • Making patients aware of multi-lingual staff that may support them.

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

Inspection carried out on 2 November 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at South Ashford Medics on 20 August 2015. The practice was found to require improvement in the provision of safe services.

We undertook this desk based follow up inspection on 2 November 2016 to confirm that the practice had improved. We reviewed written and photographic information sent to us by the practice that told us how the areas where improvement was required identified during the comprehensive inspection had been addressed. This report should be read in conjunction with the full inspection report dated 20 August 2015. A copy of the last inspection report can be found on our website www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 20 August 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at South Ashford Medics on 20 August 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework (QOF) data, this relates to the most recent information available to the CQC at that time.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, and appropriately reviewed.
  • Risks to patients were assessed and well managed, with the exception of one incident in relation to the storage of vaccines.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. The majority of staff had received training appropriate to their roles, although safeguarding training was required for some staff. Where further training needs had been identified, this had been planned.
  • Patients said they were treated with compassion, dignity and respect.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they generally found it easy to make an appointment and that urgent appointments were available the same day.
  • 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.
  • There was an active patient participation group (PPG) and feedback received within the practice from patients was acted on, although feedback from external sources, for example, responses from the 2015 national GP patient survey, had not been routinely reviewed to improve patient satisfaction.

There were areas where the provider needs to make improvements.

Importantly the provider should:

  • Monitor significant events in relation to the storage of vaccines to help ensure staff are aware of the appropriate actions to take.
  • Review the arrangements for ensuring all emergency equipment is checked regularly.
  • Review the training arrangements for staff in relation to safeguarding.
  • Review the feedback available from external sources to consider and identify ways of improving patient satisfaction.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice