Background to this inspection
Updated
6 July 2018
Shanti Medical Centre was previously inspected on 8 November 2017 when the overall rating for the practice was inadequate and they were placed into special measures. At that time we served three warning notices against the provider relating to Regulation 12 (Safe Care and Treatment), Regulation 13 (Safeguarding) and Regulation 19 (Fit and Proper Persons). In addition we served a notice of condition against the provider’s registration relating to Regulation 17 (Good Governance). The full comprehensive report on the November 2017 inspection can be found by selecting the ‘all reports’ link for Shanti Medical Practice on our website at .
We undertook a focused follow up inspection at Shanti Medical Centre on 28 March 2018. We went back to inspect whether the practice had carried out their plan to meet the legal requirements in relation to the breaches that were identified at our previous inspection in November 2017. At that inspection we reviewed only the concerns contained in the three warning notices and relevant to regulations 12, 13 and 19. The full report on the March 2018 inspection can be found by selecting the ‘all reports’ link for Shanti Medical Practice on our website at www.cqc.org.uk.
Shanti Medical Centre is a purpose built location that delivers regulated services at 130 St Helens Road Bolton BL3 3PH. The practice provides primary medical services under a General Medical Services contract to approximately 6,700 people in the immediate and surrounding areas of Bolton. More than 30% of the population are under the age of 18 years and less than 20% are over the age of 50 years. A large percentage of patients (approximately 76%) are from black and minority ethnic groups and the practice is located in an area that is number two on the scale of deprivation. People living in more deprived areas tend to have greater need for health services.
The practice is open Monday to Friday from 8am until 7.15pm. Since the previous inspections the practice has been opening on time at 8am. On-the-day appointments can be booked over the telephone and at reception and advance appointments can also be booked by telephone and on-line. There are two male and one female GPs providing approximately 30 to 40 appointments each day with six appointment sessions on Mondays to meet demand. The practice also provides telephone appointments and triage appointments each day. When the practice is closed patients are directed to the Out of Hours Service.
The practice is contracted to provide chronic disease management, immunisation, vaccination, well person and new patient checks. There is a practice nurse and health care assistant and a limited number of reception staff to support the GPs. There is no practice manager.
Full details about the practice can be found on their website www.shantimedicalcentre.nhs.uk
Updated
6 July 2018
This practice is rated as Inadequate overall
(Previous comprehensive inspection 8 November 2017 – Inadequate. Follow up focused inspection 28 March 2018 limited improvement)
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Inadequate
Are services caring? – Requires Improvement
Are services responsive? – Inadequate
Are services well-led? - Inadequate
We carried out an announced comprehensive inspection at Shanti Medical Centre on 10 May 2018 as part of our inspection programme, in response to concerns and to follow up on breaches of regulation.
At this inspection we found that there was no sufficient improvement and the concerns from the previous inspections remained the same or had got worse.
- There were no systems to manage risk so that safety incidents were less likely to happen. When something went wrong, people were not told.
- Safety was not a sufficient priority and there was no monitoring of incidents.
- The practice did not consistently and routinely review the effectiveness and appropriateness of the care it provided. Care and treatment was not always delivered according to evidence-based guidelines.
- Not all staff had the right qualifications, skills, knowledge and experience to do their job effectively and the learning needs of staff were not supported.
- Other stakeholders had raised concerns about the care and treatment at the practice.
- The needs of the local population were not fully identified or taken into account when planning services, for example in the case of cervical screening.
- Leaders were not working together for the benefit of the service and patients.
- Leaders did not consistently have the knowledge, capacity or desire to deliver an effective service and were out of touch with what was happening on a daily basis. There was a lack of clarity about who had the authority to make decisions and quality and safety were not top priority. There was no clear vision or guiding values.
- There was no innovation or service development and improvement was not a priority among staff and leaders.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure care and treatment is provided in a safe way to patients in line with current guidance.
- Ensure systems are in place so patients are protected from abuse and improper treatment
- Ensure there is an effective system for identifying , receiving ,recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
- Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment
- Ensure specified information is available regarding each person employed; ensure that any such action as is necessary and proportionate is taken when any member of staff is no longer fit to carry out their duties
Insufficient improvements have been made such that there remains a rating of inadequate overall. We will now 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.
The service will be kept under review and if needed could be escalated to urgent enforcement action.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice