Tadworth Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tadworth Medical Centre on 3 November 2016. Overall the practice is rated as Good.

Tadworth Medical Centre was subject to a previous comprehensive inspection in July 2015 where the practice was rated overall as Requires Improvement but more specifically Inadequate for providing safe services. We re-inspected the practice in March 2016 and found that it had not addressed all of the issues previously found. As a result the practice was rated overall as Inadequate and was placed into Special Measures. (The practice had been rated in March 2016 as Inadequate for providing safe and well led services, as Requires Improvement for providing effective, responsive services and as Good for providing caring services).

Following our inspection of the practice in March 2016, the practice sent us an action plan detailing what they would do to meet the regulations. We undertook this comprehensive inspection on 3 November 2016 to check that the provider had followed their action plan and to confirm they now met the regulations. We found the practice had made significant improvement since our previous inspection. The practice is now rated as Good overall.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Governance processes were well planned and implemented.
• Continuous improvement was planned and reviewed to ensure improvement within the practice. For example, the practice had reviewed performance for diabetes related indicators which were significantly below the national average and had put in place patient audits, additionally trained staff and additional nursing hours to improve results.
• Risks to staff, patients and visitors were formally assessed and monitored. For example, the practice had processes in place for identifying, recording and managing risks for legionella, fire safety and infection control.
• The infection control lead had undertaken additional training and up-to-date infection control audits had been carried out. Findings had been reviewed and appropriate action taken to address any concerns.
• Staff had received training appropriate to their roles and further training needs had been identified and planned. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Staff had received an appraisal of their performance which was recorded and well managed. Performance management processes were well defined.
• Urgent appointments were usually available on the day they were requested. However, patients rated the practice significantly below average for several aspects of their ability to access services. In response to this the practice had added extended hours appointments at the practice on Tuesday and Thursday from 7.30am to 8am, and on Monday and Wednesday from 6.30pm to 7.30pm. The practice’s own patient survey results showed a significant improvement in how patients rated access to services.
• The practice participated in a locality initiative which enabled patients to access appointments from 6.30pm to 9.30pm Monday to Friday and from 9.30am to 1.30pm on Saturdays and Sundays at four different locations (Epsom, Nork, Leatherhead and from Tadworth Medical Centre).
• The practice was an accredited practice with Epsom and Ewell Foodbank (the Trussell Trust) to provide food vouchers to those in urgent need.
• 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 the national patient survey results and ensure that measures are put in place to secure improvements where scores are below average.
• Continue to monitor QOF indicators and ensure that measures are put in place to secure improvements in relation to scores which are below the national average.
• The provider should continue to identify a greater proportion of carers from its patient list, to better support the population it serves.

I am taking Tadworth Medical Centre 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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Tadworth Medical Centre on 8 March 2016. Overall the practice is rated as inadequate.

The practice was subject to a previous comprehensive inspection in July 2015. At our previous inspection of Tadworth Medical Centre, the practice was rated as inadequate for providing safe services, requires improvement for providing effective, responsive and well-led services and good for providing caring services. Following our comprehensive inspection of the practice in July 2015, the practice sent us an action plan detailing what they would do to meet the regulations. We undertook this comprehensive inspection on 8 March 2016 to check that the provider had followed their action plan and to confirm that they now met the regulations. At this inspection we found that whilst some improvements had been made, many of the findings of our previous inspection had not been addressed.

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

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• The practice worked closely with other organisations and with local community services in planning how care was provided to ensure that they met people’s needs.
• Staff had not always received training appropriate to their roles and further training needs had not always been identified and planned.
• The practice had introduced some processes to provide staff with appraisal of their performance. However, those activities were not always recorded or well managed. Performance management processes were not well defined.
• Governance processes were not always well planned and implemented in some areas.
• Infection control audit findings had not been reviewed nor appropriate action taken to address the findings.
• Risks to staff, patients and visitors were not always formally assessed and monitored.
• There was a lack of arrangements for identifying, recording and managing risks, issues and implementing mitigating actions in some areas.
• There was a lack of oversight, planning and review of actions to ensure continuous improvement within the practice. For example, to address performance for diabetes related indicators which were significantly below the national average.
• Urgent appointments were usually available on the day they were requested. However, patients rated the practice significantly below average for several aspects of their ability to access services.
• 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.
• The practice implemented suggestions for improvements and made some changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

The areas where the provider must make improvements are:

• Ensure staff undertake training to meet their needs, including planned induction, training in fire safety, anaphylaxis, chaperoning and infection control.
• Ensure all necessary and relevant checks are undertaken for staff prior to employment.
• Ensure all staff receive regular supervision and documented appraisal which includes objective setting.
• Ensure there are formal arrangements in place for assessing and monitoring risks to staff, patients and visitors, including fire safety arrangements and the management of medical emergencies. Ensure actions are taken to respond to identified health and safety risks.
• Ensure governance arrangements are fully implemented and monitored in order to promote continuous improvement within the practice.
• Ensure review of patient treatment outcomes and appropriate risk assessment and action planning. For example, in the management of patients with diabetes and those with hypertension.
• Ensure all actions identified by infection control auditing processes are implemented.
• Ensure the safe disposal of all sharps items within the practice.
• Ensure further action is taken in response to feedback gathered from patients, in order to improve access to the practice by telephone.

The areas where the provider should make improvements are:

• Implement systems to support managers in performance management processes.

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