Gravesend Medical Centre

We carried out an announced inspection at Gravesend Medical Centre. We conducted remote clinical searches on the practice’s computer system on 26 July 2022 and conducted an onsite inspection of the practice on 27 July 2022 under Section 60 of the Health and Social Care Act 2008, as part of our regulatory functions.

The key questions at this inspection are rated as:

Safe – Requires Improvement

Effective – Requires Improvement

Responsive - Good

Well-led – Requires Improvement

Overall, the practice is rated as Requires Improvement.

Following our previous inspection on 29 June 2016, the practice was rated Good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Gravesend Medical Centre on our website at www.cqc.org.uk.

Why we carried out this inspection

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

We checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection focused on the following:

• Are services safe?
• Are services effective?
• Are services responsive in relation to access?
• Are services well-led?

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing,
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider,
• Reviewing patient records to identify issues and clarify actions taken by the provider,
• Requesting evidence from the provider,
• A short site visit.

Our findings

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, patients, the public and other organisations.

We have rated this practice as Requires Improvement overall.

We rated the practice as Requires Improvement for providing safe services because:

• Improvements were required in relation to the management and oversight of staff personnel files, particularly in relation to non-clinical staff, for example, Disclosure and Barring Service checks and staff immunisations.
• The provider did not have processes to regularly check the temperature of the hot and cold outlets on the premises in relation to the control of legionella.
• Appropriate standards of cleanliness and hygiene were met. However, some improvements were required.
• Not all staff were suitably trained in basic life support.
• Blank prescriptions were not always kept securely, and their use were not monitored in line with national guidance.
• Improvements were required in relation to the monitoring and assessment of patients’ health in relation to the use of high-risk medicines.
• Systems for managing safety alerts were not always effective.

We rated the practice as Requires Improvement for providing effective services because:

• Patients’ needs were not always assessed, and care and treatment was not always delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
• Performance relating to cervical cancer screening and the identification and timely referral of new cancer cases required improvement.

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

• There were processes for managing risks, issues and performance. However, these were not always effective.

We found that:

• The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• The practice had systems, practices and processes to keep people safe and safeguarded from abuse however, some improvements were required.
• The practice learned and made improvements when things went wrong.
• The practice always obtained consent to care and treatment in line with legislation and guidance.
• There was compassionate, inclusive and effective leadership at all levels.
• Staff worked together and with other organisations to deliver effective care and treatment.
• Staff were consistent and proactive in helping patients to live healthier lives.
• People were able to access care and treatment in a timely way.
• The practice had a culture which drove high quality sustainable care.
• The practice involved the public, staff and external partners to sustain high quality and sustainable care.
• There was evidence of systems and processes for learning, continuous improvement and innovation.

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.

The areas where the provider should make improvements are:

• Continue to implement and monitor the outcome of plans to improve childhood immunisation uptake.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care