Maples Family Medical Practice

We carried out an announced comprehensive inspection at Maples Family Medical Practice on 16 October 2019.

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.

We have rated this practice as requires improvement overall.

This is a follow up inspection from the announced comprehensive inspection at Maples Family Medical Practice on 5 February 2019. The overall rating for the practice was inadequate and the practice was placed into special measures for a period of six months. A warning notice was served in relation to breaches identified under Regulation 17 good governance. We completed an announced comprehensive inspection on 16 October 2019 to check on the areas identified in the warning notices and to see if sufficient improvements had been made regarding these. The practice had taken some of the actions needed to comply with the legal requirements.

This announced comprehensive inspection on 16 October 2019 was carried out following the period of special measures to ensure improvements had been made and to assess whether the practice could come out of special measures. 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

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

• The practice did not have overall oversight of all significant events and we were not assured that there was learning within the wider teams.
• Not all clinical staff were aware of where the emergency medicines and equipment were held.
• It was not clear that there was an effective system for all alerts to be received and reviewed in the practice.

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

• There was limited evidence of shared clinical audits and learning within the practice. We found there was limited monitoring of the outcomes of care and treatment.
• The system used to recall patients with long-term conditions for a structured annual review to check their health and medicines needs were being met but was not effective.
• The practice did not have arrangements for following up failed attendance of children’s appointments following an appointment in secondary care.
• The practice had higher than average exception reporting for some indicators relating to people experiencing poor mental health.

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

• The practice did not have clear oversight of complaints and we were not assured risk was being monitored.
• We found that the practice did not undertake routine care plans for dementia patients.
• The practice did not have a system in place to improve their GP patient survey results.

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

• The practice did not have a comprehensive programme of quality improvement.
• The practice did not have effective governance systems and processes in place.
• Although the practice were developing a business plan there was not one in place at the time of inspection.
• Although there were systems in place for identifying, managing and mitigating risks, these needed to be strengthened and embedded.

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 practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• Patients told us that they feel engaged in their care and treatment and would recommend the practice.
• The practice had an alert system for recently bereaved patients to provide additional support.

We rated all population groups as requires improvement .

The practice has been rated requires improvement in effective and responsive and this applies to all population groups.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients

In addition, the provider should:

• Review the staff training to make sure all staff are aware where emergency medicines are stored.
• Manage an effective overview of all significant events and complaints and share learning.
• Review and act upon patient feedback to improve experiences for patients.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

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

We carried out an announced comprehensive inspection at Maples Family Medical Practice on 5 February 2018 as part of our inspection programme.

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.

We have rated this practice as inadequate overall.

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

• The practice did not always have clear systems and processes to keep patients safe.
• Systems to support appropriate standards of cleanliness and hygiene were not in place.
• The practice did not always have appropriate systems in place for the safe management of medicines.
• There were gaps in the systems to assess, monitor and manage risks to patient safety.
• The practice did not always learn and make improvements when things went wrong.

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

• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.
• The system used to recall patients with long-term conditions for a structured annual review to check their health and medicines needs were being met was not effective.

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.

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

• Patients feedback that they were not always able to access care and treatment in a timely way.

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

• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
• While the practice had a clear vision, that vision was not supported by a credible strategy.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.

We rated all population groups as requires improvement.

The areas where the provider must make improvements are:

• 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).

In addition, the provider should:

• Continue to implement and embed the system for recalling patients with long term conditions to ensure their care and treatment needs are met.

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.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice