Archived: Manchester Road Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manchester Road Surgery on 10 May 2017. The overall rating for the practice was inadequate, and we issued warning notices for breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe care and treatment) and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance). Two requirement notices were also issued for breaches identified of Regulations 13 (Safeguarding service users from abuse and improper treatment) and 16 (Receiving and acting on complaints). The full comprehensive report following the inspection in May 2017 can be found on our website here: http://www.cqc.org.uk/location/1-550124196/reports.

This inspection was an announced focused inspection carried out on 10 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches identified within the warning notices for regulations 12 and 17.

Our key findings were as follows:

• Improvements had been made to the management of risks to both patients and staff.

• A systematic approach had been implemented to ensure that patient’s medicine reviews were completed in a timely manner.

• Patients prescribed high risk medicine were proactively monitored to ensure all information required by the GPs was available to ensure safe prescribing.

• A system of delegated responsibility was in palce to ensure vaccine fridge temperatures were monitored appropriately in the practice nurse’s absence.

• An action plan had been produced following an infection prevention and control audit and the practice were in the process of addressing risks identified.

• Safeguarding registers had been set up on the electronic patient record system in order to provide managerial oversight of vulnerable patients.

• A system was in palce to proactively monitor patients referred to secondary care using urgent referral pathways and ensure they were offered an appointment in an appropriate timescale.

• The practice was in the process of inviting patients with dementia for an appointment to agree care plans.

• Staff were aware of translation services available to patients whose first language was not English.

At our previous inspection on 10 May 2017, we rated the practice as inadequate and placed the service into special measures. As per our published inspection methodology, a further full comprehensive inspection visit will be carried out shortly in order to monitor the work the practice has begun to implement around the required improvements to the 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 at Manchester Road Surgery on the 26 November 2015. The overall rating for the practice was requires improvement, with key questions Safe, Effective and Well Led rated as requires improvement. The inspection identified that recruitment arrangement and staff training and support was not good enough. A planned programme of clinical audit was not implemented. The identification and management of risk needed improving and systems to ensure single use equipment had not passed their expiry date were not in place. Systems to ensure GPs reviewed patient prescriptions added to the patient electronic record by administration staff were not in place. We issued four requirement notices for breaches of regulation and the practice submitted an action plan detailing how they intended to improve the service they provided. The full comprehensive report on the November 2015 inspection can be found by selecting the ‘all reports’ link for Manchester Road Surgery on our website at www.cqc.org.uk.

This inspection was a follow up announced comprehensive inspection on 10 May 2017. Overall the practice is now rated as Inadequate.

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

• Since the last inspection the practice had improved the system for reporting and recording significant events and ensuring all staff were made aware of any learning and improvement from incidents.
• Actions undertaken by the practice to ensure health care risks for patients were minimised were inadequate. For example there was no safeguarding policies available specific to the practice and contact telephone numbers to local safeguarding teams were not available except in one GP consultation room. Safeguarding registers for children or vulnerable adults were not maintained and GPs could not tell us how many children were designated at risk or how many had a child protection plan in place.
• Systems to ensure patients received timely medication reviews and the appropriate health care checks such as blood tests were not in place potentially putting patients at risk.
• Recorded care plans were not available, checks to monitor patients prescribed high risk medicines such as disease-modifying anti-rheumatic drugs (DMARDs) were disorganised and checks to monitor patients referred urgently to see a specialist on the two week pathway were reactive.
• Improvements had been made to staff recruitment checks since the last inspection. Recruitment records included Disclosure and Barring Service checks (DBS) for staff employed at the practice.
• Staff had received an annual appraisal since the last inspection and clear evidence was available of the training staff had received. However GPs confirmed that they had not had health and safety training including fire safety and records to demonstrate they had had infection control and prevention training were not available.
• Urgent appointments were usually available on the day they were requested. Although patients told us that getting a routine appointment was difficult.
• The practice’s policies and procedures had been reviewed but we noted these were generic policies and were not adapted to reflect the practices procedures.
• Parts of the practice environment was in need of refurbishment, however a maintenance or refurbishment plan was not in place.
• Governance arrangements to monitor and review the service provided were not effective and this had resulted in gaps in service delivery and performance.
• The practice had updated their complaints policy since the last inspection. However the policy was incomplete and the practice procedure did not align with their policy.
• Staff confirmed they attended two to three monthly team meetings which they found useful.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

The areas where the provider must make improvements are:

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

In addition the provider should:

• Improve procedures to reflect national good practice in obtaining a written consent before minor surgery is undertaken.
• Strengthen the practice’s procedure to safeguard both patients and GPs by recording within the patient record a note of the patients’ blood clotting rate (INR), the dose of medicine prescribed and when the next check was due.
• Establish a rolling programme of regular clinical audit and re-audit.
• Develop the practice’s patient reference group to provide opportunities for more participation by holding face to face meetings.
• Develop the practice’s policy on equality to ensure patients have access to independent interpreting services.

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