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Archived: Melrose Surgery - Dr Fab Williams & Partner Inadequate

Reports


Inspection carried out on 18 September 2015

During a routine inspection

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 carried out on 25 June 2015

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

The practice underwent a comprehensive inspected on 21 January 2015. We found concerns related to the safety, effectiveness, responsiveness and leadership of the practice. It was rated inadequate and was placed into special measures. We issued a Warning Notice and four Requirement Notices to the practice. This report is available on our website.

We then carried out a focussed inspection at the practice on 13 March 2015 in response to information that the lead GP partner was absent and that there was potentially a shortage of GP cover that could effect patient care. This led to a suspension of the practice’s registration to perform regulated activities from 17 March 2015 due to the concerns we identified.

On the 7 April 2015 the suspension ended and we undertook a further focussed inspection on 20 April 2015 to determine whether the practice was providing the services patients needed. Due to ongoing concerns we issued another warning notice under regulation 12(1)(2)(a)(b) of the Health and Social Care Act requiring compliance by 15 June 2015.

On 25 June 2015 we undertook a focussed inspection to check on the progress made against the Warning Notices

Our key findings were as follows:

  • The lead GP partner was not working at the practice and the other partner only working Thursday mornings. There was locum cover until the end of August, but with no extended hours appointment availability.

  • There were approximately 20-24 daily appointments available, except on Thursdays when there was half that number.

  • An external professional had been employed to help identify the extent of patients overdue medicine and long term condition reviews. There was a plan and some progress in dealing with this backlog of reviews.

  • Staff meetings were taking place where incidents and some complaints were being discussed.

  • Some services were no longer being provided, such as medical checks sometimes required by patients’ employers.

  • Although a general communication protocol was in place regarding the circumstances at the practice from April 2015, there was a lack of effective communication with staff and patients about the availability of services.

  • There had been a review of risks identified, such as disabled access and medicines available for medical emergencies which may occur.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 13 March and 20 April 2015

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

The practice underwent a comprehensive inspected on 21 January 2015. We found concerns related to the safety, effectiveness, responsiveness and leadership of the practice. It was rated inadequate and was placed into special measures. This report is available on our website.

We then carried out a focussed inspection at the practice on 13 March in response to information that the lead partner was absent and that there was potentially a shortage of GP cover. This led to a suspension of the practice’s registration to perform regulated activities from 17 March 2015 due to the concerns we identified.

On the 7 April 2015 the suspension ended and we undertook a further focussed inspection on 20 April to determine whether the practice was providing the services patients needed.

A management review meeting following these focussed inspections was held on 21 April and further reviewed on 7 May when it was agreed to issue a warning notice under regulation 12(1)(2)(a)(b) of the Health and Social Care Act requiring compliance by 15 June 2015

Our key findings were as follows:

  • On 13 March staff confirmed that the lead partner had not been working at the practice since 3 March 2015 due to illness.

  • This GP had provided the vast majority of appointments prior to this, with the other partner only working Thursday mornings.

  • There was no interim GP cover during this absence. The other GP in the practice was providing 1.5-2 hours of cover per day to provide some GP appointments.
  • From 3 March 2015 there was a large reduction in available appointment slots.

  • On 20 April we found that there had been a locum GP employed until the end of May to cover eight sessions per week (this is approximately 20 appointments per day). Extension of the locum arrangement beyond the end of May would be possible subject to further negotiation.

  • Appointments were being offered to patients and the number of appointments matched the level provided prior to the lead partner’s absence.

  • There was no plan to deal with any overdue long term condition reviews caused by the absence of the lead partner.

  • We found the patient record system was not being monitored properly to ensure patients’ health was monitored and that they received appropriate treatment for any conditions.

  • A practice manager had been employed to support staff and improve the governance of the practice.

Importantly, the provider must:

  • Identify the backlog of patients who need long term condition reviews and the number of patients who are overdue medicine reviews.
  • Ensure there is adequate GP hours at the practice to meet the needs of patients including those who are overdue medicine reviews, long term condition reviews or other health checks which are required within a specific timeframe.
  • Improve the recording of patients’ notes to ensure they are up to date and accurate.
  • Assess what emergency medicines are required onsite and ensure they are made available

Action the provider should take to improve

  • Continue to review communication between staff to ensure they are suitably informed of the situation and are supported to fulfil their roles.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 21 January 2015

During a routine inspection

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