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Archived: Melrose Surgery - Dr Fab Williams & Partner Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 19 November 2015

Letter from the Chief Inspector of General Practice

 

We carried out an announced comprehensive inspection at Melrose Surgery Dr FAB Williams and Partner on 18 September 2015. This inspection covered areas of concern we identified at our last comprehensive inspection in January 2015, after a six month period of the practice being in special measures. On the date of inspection visit several staff members were absent and access to information we needed was limited. Some information we requested was not sent to us. Therefore some sections of the report do not have the range of evidence we would usually gather.

At this inspection our key findings across all the areas we inspected were as follows:

  • The practice was due to close on the 9th October 2015 and the patients registered at Melrose Surgery Dr FAB Williams and Partner were to be transferred to the neighbouring GP provider.
  • Risks to patients were often not identified, assessed or well managed.
  • Staff were not always provided with the protocols and awareness they needed to respond to emergencies.
  • Medical equipment and drugs were available but emergencies were not appropriately planned for.
  • Infection control and hygiene of clinical areas was not effectively monitored.
  • Medicines were not monitored appropriately
  • Patients had not been informed via signs in the practice or on the website that the practice had a rating of inadequate given following the inspection in January 2015.

  • Staff had processes to follow in order to raise concerns, and to report incidents and near misses. Information about safety was recorded, and reviewed.
  • Patients’ medical needs were being assessed and care was planned and delivered following national guidance
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • The practice was mostly clean but we found areas of dust in treatment rooms. Maintenance had improved since our inspection in January 2015.
  • There was monitoring of patient care but this was not in the form of a cohesive programme of clinical audit. The practice had prioritised resources in the identification of patients overdue medical and long term condition reviews to ensure their care was effective and safe, over recent months.
  • Information about services and how to complain was not easily available.
  • Access to appointments was good. Appointments were available the same day.
  • Accessibility for disabled patients had been improved but it was still not appropriately assessed despite the concerns being raised in January 2015.
  • Meetings had been introduced for staff communication but staff did not always feel supported by the leadership team.

  • The practice did not communicate effectively with patients to advise them of the closure of the practice. Some patients reported being very concerned at the lack of communication.

There were areas of practice where the provider must make improvements:

  • Improve infection control procedures including the monitoring of cleaning
  • Fully prepare the service for medical and other emergencies by ensuring staff have the correct drugs, training and awareness of how to respond to emergencies which may occur.
  • Monitor medicines to ensure they are safe and effective.
  • Put in place a full programme of clinical audit including responsive audits where data suggested that improvements to the service can be made.
  • Ensure patients with limited mobility can access the service safely and where possible independently.
  • Improve communication with patients specifically in regards to the transfer of patients to another practice.
  • Review systems of governance to reflect the needs of the practice and to support staff in their roles.
  • Display the practices rating of its performance by the Commission following an inspection.

The practice has been rated as inadequate overall after the inspection in September 2015, which followed the practice being placed into special measures in January 2015. The provider will be cancelling their own registration and a new NHS England contract, with a new provider, commenced on 9 October 2015.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Inadequate

Updated 19 November 2015

The practice is rated as inadequate for providing safe services. Infection control and medicines management procedures were not followed by staff. Medical emergencies were not planned for appropriately and staff were not always provided with appropriate information regarding events which may impact on the running of the service. Staff had systems to follow in order to report incidents and near misses.

Effective

Requires improvement

Updated 19 November 2015

The practice is rated as requires improvement for providing effective services. Data showed patient outcomes were similar to average for the locality. However, there was no programme of clinical audit. Staff referred to guidance from the National Institute for Health and Care Excellence and used it routinely. Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. We were not able to review staff records of training. Staff worked with multidisciplinary teams.

Caring

Requires improvement

Updated 19 November 2015

The practice is rated as requires improvement for providing caring services. Patients were unhappy because they had not been informed about the closure of the practice. Some patients were still being registered at the practice despite the imminent closure. There was no curtain in the nurse’s treatment room to protect patients’ dignity and confidentiality. Data showed that patients rated the practice similarly to others for several aspects of GPs’ care. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Feedback regarding reception staff was very positive in comparison to the local and national average. Information for patients about the services available was easy to understand and accessible. We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Requires improvement

Updated 19 November 2015

The practice is rated as requires improvement for providing responsive services. Patients were not communicated with effectively. Information about how to complain was not easily available. Accessibility for patients with limited mobility was not properly assessed and not all changes made to ensure access was safe had been made, despite the problem being reported after our inspection in January 2015. Patients were able to make an appointment in advance or on the day; feedback from patients indicated appointments were accessible. Complaints were responded to. Learning from complaints was shared with staff and other stakeholders.

Well-led

Inadequate

Updated 19 November 2015

The practice is rated as inadequate for being well-led. It did not have a clear strategy for the closure of the practice and the transfer of patients to the new GP practice. Staff were not always clear about their responsibilities. The practice had a number of policies and procedures to govern activity but these were often not related specifically to the practice. Regular governance meetings were held. Systems to monitor and identify risk were not always followed by staff. The practice proactively sought feedback from staff and patients but did not report on this as required by their contract. There was no patient participation group (PPG).

Checks on specific services

Older people

Inadequate

Updated 19 November 2015

The practice is rated as inadequate for the care of older people. There were concerns which led to ratings of in the effective, caring and responsive domains and to ratings of inadequate for safety and well-led. These concerns related to all the population groups. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice provided reviews of conditions often associated with aging such as dementia and screening for such conditions was offered to patients. Home visits were offered by an external GP and same day appointments were also available.

People with long term conditions

Inadequate

Updated 19 November 2015

The practice is rated as inadequate for the care of people with long-term conditions. There were concerns which led to ratings of requires improvement in the effective, caring and responsive domains and to ratings of inadequate for safety and well-led. These concerns related to all the population groups. The nurse led the reviews of patients with chronic disease. Longer appointments and home visits were available when needed. A locum GP was providing the majority of appointments and the remaining GP partner provided appointments once a week. Multi-disciplinary working took place where necessary. There was improved monitoring of long term conditions since the inspection undertaken in April 2015. However, there was no programme of clinical audit to identify and embed improvements for this group of patients.

Families, children and young people

Inadequate

Updated 19 November 2015

The practice is rated as inadequate for the care of families, children and young people. There were concerns which led to ratings of requires improvement in the effective, caring and responsive domains and to ratings of inadequate for safety and well-led. These concerns related to all the population groups. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were close to the national average for all standard childhood immunisations. Child immunisations had been suspended in July 2015 and August 2015 meaning the numbers of these completed for the year so far were lower than expected. Pre and post-natal appointments with a GP were undertaken at a nearby practice in Reading. A midwife also saw patients in the practice. Facilities including access for buggies and prams had not been improved significantly since our inspection in January 2015.

Working age people (including those recently retired and students)

Inadequate

Updated 19 November 2015

The practice is rated as inadequate for the care of working age people (including those recently retired and students). There were concerns which led to ratings of requires improvement in the effective, caring and responsive domains and to ratings of inadequate for safety and well-led. These concerns related to all the population groups. No extended hours appointments were available which potentially affected this group of patients the most. Access during normal working hours was good. Phone access to the practice was rated highly by patients. This was particularly useful for patients calling at peak times for appointments such as those who work full time.

People whose circumstances may make them vulnerable

Inadequate

Updated 19 November 2015

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. There were concerns which led to ratings of requires improvement in the effective, caring and responsive domains and to ratings of inadequate for safety and well-led. These concerns related to all the population groups. The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It offered annual health checks and longer appointments for people with a learning disability. Phone translation services were available for patients who did not have English as a first language. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.

People experiencing poor mental health (including people with dementia)

Inadequate

Updated 19 November 2015

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). There were concerns which led to ratings of requires improvement in the effective, caring and responsive domains and to ratings of inadequate for safe and well-led. These concerns related to all the population groups. Dementia screening was offered to patients deemed at risk of the condition. Care plans were developed for some patients with poor mental health. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Records showed that monitoring of medication for patients on anti-depressants took place.