The Care Quality Commission
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Archived: Melrose Surgery - Dr Fab Williams & Partner

Overall: Inadequate read more about inspection ratings

Melrose House, 73 London Road, Reading, Berkshire, RG1 5BS (0118) 950 7950

Provided and run by:
Melrose Surgery - Dr Fab Williams & Partner

All Inspections

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

25 June 2015

During an inspection looking at part of the service

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

25 June 2015

During an inspection of this service

13 March and 20 April 2015

During an inspection looking at part of the service

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

21 January 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We inspected Melrose Surgery - Dr FAB Williams & Partner on 21 January 2015. This was a comprehensive inspection.

We have rated the practice as inadequate, because improvements in safety, responsiveness to patients’ needs, leadership and culture are required. On the basis of our findings and our judgements we are placing the practice into special measures.

Our key findings were as follows:

  • National data showed the practice performed well in managing long term conditions but there was no system to drive clinical improvements through audits.
  • Patients told us they were able to access appointments but some patients wanted a choice of female GP which was difficult as the female GP only worked one morning per week.
  • The premises were not safely accessible for wheelchair users and access for buggies and prams was restricted. The practice was not clean in some areas and systems to manage infection control and cleanliness was poor.
  • Medicines were checked and stored safely.
  • Significant events and incidents were not reported by staff as they did not have a protocol or awareness of how to escalate concerns. Significant events and complaints were not investigated to ensure that where improvements were required, they were made.
  • The practice did not have a plan for foreseeable emergencies which may occur and impact on the running of the service. There was no assessment to determine what equipment and medicines should be available in the event of a medical emergency.
  • Not all the needs of the patient population were planned for, specifically those who may be most vulnerable.
  • There was not a clear staff structure to identify responsibilities and staff were not supported to fulfil their roles.
  • The practice was not registered for the regulated activity of Maternity and Midwifery services but was providing services to patients which required them to be registered for this regulated activity at this time of the inspection and the practice did not have a registered manager, a condition of their registration with the CQC. No applications were received by the date of the inspection.

There are areas where the provider must make improvements:

  • ensure the monitoring of hygiene and infection control is adequate and reflects national guidelines and that medical instruments are cleaned in line with manufacturer’s instructions
  • review the system for identifying, recording and taking action when significant events occur to ensure that risks are identified and managed properly and where needed, improvements are made to the quality of service
  • ensure employment checks are undertaken in line with legal requirements registration with professional bodies, references and employment histories
  • review patient specific group directives required for the nurse to administer vaccines
  • ensure vulnerable adults and children at risk of abuse are coded on the on patient record system so they can be highlighted to reception staff, GPs and nurses as part of the processes for protecting patients against abuse
  • undertake a risk assessment and plan for medical emergencies to ensure that the practice is equipped to deal with them
  • implement contingency plans for foreseeable emergencies.
  • undertake a review and risk assessment of access to the practice for patients with mobility difficulties, who use wheelchairs, prams and buggies.
  • provide staff with opportunities for communication and involvement in governance to ensure staff are involved in the running of the service
  • create an audit schedule to ensure improvements to clinical practice are identified and implemented using complete clinical audit cycles as part of a system of monitoring and assessing the quality of the service
  • ensure staff have their roles defined and that they have the support required to fulfil them

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice