Archived: St Marys Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Marys Medical Centre on 10 February 2016. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe, effective, caring and well-led services. Improvements were also required for providing responsive services. The concerns which led to these ratings apply across all the population groups we inspected.

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

• Patients were at risk of harm because the systems and processes in place did not always ensure the safety of patients. For example, patient records were not always updated following consultations, and some follow-up tasks had not been actioned by the GP.

• The practice team were unclear regarding their responsibilities to report incidents and near misses, and there was no evidence of learning by sharing findings with staff. Reviews and investigations were not thorough enough to identify key issues.

• The provider did not have robust processes to support child and adult safeguarding. Documentation was inaccurate, and there was no liaison with other professionals in relation to those individuals considered to be at risk. Policies were out of date and lacked clarity. The practice had not identified any vulnerable adults on their patient list.

• We saw limited evidence that audits were driving improvement in performance to improve patient outcomes.

• The practice could not provide evidence that they had completed actions identified by an external infection control audit undertaken in March 2015. Staff had not been offered immunisations to prevent the risk of cross-infection. Therefore, there was a potential safety risk to patients and staff on site.

• Nationally reported data showed that most of the patient outcomes were comparable with local and national averages.

• Patients told us that it was easy to get an appointment to see a GP. Patients told us they felt they were cared for well, and were positive about their interactions with staff. They told us that they were treated with compassion and dignity.

• The provider had insufficient leadership capacity and did not employ a practice manager. Most of the duties were covered by one of the GP partners who was primarily based at a different location.

• The overarching governance framework did not operate effectively, nor support the delivery of good quality care. For example many policies and procedures were overdue a review and some were absent. Employed staff had not received an annual appraisal.

• There were insufficient staffing levels to ensure safety and provide effective service delivery. There was usually only one GP and one receptionist on site. The practice did not employ nursing staff.

• Information about services and how to make a complaint was available in the waiting area, although the complaints information did not provide sufficient detail for patients.

• The practice did not have an active Patient Participation Group (PPG) and therefore patients did not have a robust mechanism to ensure the voice of patients was heard.

• Staff files were not organised efficiently. Details of pre-recruitment checks were largely absent and training details were not recorded and updated centrally.

The areas where the provider must make improvements are:

• Implement robust and effective systems for identifying and managing child and adult safeguarding concerns.

• Ensure patients receive safe care and treatment and risks are mitigated by; introducing robust processes for reporting, recording, investigating, acting on and monitoring significant events, incidents and near misses; carrying out completed clinical audits to improve patient outcomes; taking action to address the identified concerns with infection prevention and control practice; ensuring systems for checking medicines within the practice are strengthened and ensuring patient records are contemporaneous and accurate .

• Ensure effective systems are in place to enable the provider to seek and act on feedback in order to constantly evaluate the services by ensuring that people affected when things go wrong receive reasonable support, and an apology where necessary.

• Ensure effective systems are in place to enable the provider to identify, assess and mitigate risk for example by ensuring recruitment arrangements are robust, records can be found and accessed easily and staff files contain evidence of all necessary pre-employment checks for all staff.

• Ensure effective systems are in place to enable the provider to assess and monitor the quality of service by providing staff with up to date and appropriate policies and guidance to carry out their roles in a safe and effective manner, which reflect the requirements of the practice and local and national guidance, implementing formal governance arrangements, ensuring there is leadership capacity to deliver all improvements; ensuring there is sufficient clinical capacity to provide cover for GPs and ensuring effective systems are in place to record staff training and staff appraisals.

In addition the provider should:

• Ensure risk assessments are considered when risks have been identified. For example, lone working arrangements and the absence of a defibrillator on site.

Further to the inspection, we have taken urgent suspension enforcement action for a period of three months under Section 31 of the Health and Social Care Act 2008, which is subject to a right of appeal. Further to the inspection, we have taken urgent suspension enforcement action for a period of three months under Section 31 of the Health and Social Care Act 2008, which is subject to a right of appeal. An appeal was lodged by the provider which has been heard and dismissed by the First-tier Tribunal.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains 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 practice 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.

Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice