Drs Green, Majeed and Shetty

We carried out an announced comprehensive inspection at Drs Green, Broadbelt and Majeed (Also known as Vittoria Medical Centre) on 12 September 2019.

This inspection was to follow-up on breaches found at the previous inspection in March 2019 at which we found breaches in Regulation 12, Safe care and treatment because high risk medicines were not managed safely and Regulation 16 because complaints were not dealt with in keeping with the regulations. At this follow up inspection we found action had been taken to ensure high risk medicines were managed safely and processes had been put in place to ensure complaints were dealt with correctly.

We found however, that systems and processes in place to support effective and sustained improvements needed strengthening.

We looked at all five key questions.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We rated the practice as good for providing safe, effective, responsive and caring services.

We have rated this practice as requires improvement in well-led.

We found:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm. At the previous inspection systems were not in place to ensure patients on high risk medicines had the required health checks to keep them safe and medicine safety alerts had not been responded to as required. At this follow-up inspection systems had been put in place to promote patient safety. The systems included identifying and keeping in touch, appropriately, with all relevant patients.
• Patients generally received effective care and treatment that met their needs. We saw that clinicians treated and cared for patients in line with current best practice guidelines.
• The practice delivered care and treatment tailored to the individual’s needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way. At the previous inspection the practice did not deal with complaints and comments openly or provide enough information about how to complain. At this inspection the practice had made improvements and could show they had listened to the complainant and addressed complaints correctly. Patients were provided with the information and support needed to raise concerns and information about how to contact the Parliamentary and Health Services Ombudsman was provided.

We rated the practice as requires improvement for providing well-led services because:

• The leadership style and ethos promoted the delivery of high-quality, person-centre care however, the managerial systems did not fully support the delivery of safe and effective services.
• Recent procedural changes had been implemented or were planned, for example: the contents of GP bags were now regularly checked; a new policy to manage prescriptions was in place; plans to scrutinise antibiotic prescribing had been discussed and the development of the clinical audit plan. However, processes needed to support on-going changes were not embedded.
• Analysis of information gathered by the provider lacked detail and did not identify possible areas for improvements. For example, from patient surveys; fire drills or training and recruitment records.
• A clinical audit program had been recently developed however, an operational audit program had not been developed.
• Key roles had not been allocated for example an infection prevention and control lead had not been identified.

The area where the provider must make improvements is:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The area where the provider should make improvement is:

• Consider providing a data logger for both vaccine fridges.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Drs Green Broadbelt and Majeed, Vittoria Medical Centre on 19 March 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall and requires improvement for all population groups.

We rated the practice as good for providing effective, caring and well led services.

We found:

• The practice had some safe systems and practices in place such as those in respect of safeguarding people from abuse, prevention and control of infections, safe recruitment of staff and management of health and safety risks.

• There was equipment and medicines for use in emergencies and these were checked and documented. However, we found some equipment in GP bags that had not been serviced or calibrated as required.
• Blank prescriptions were logged in and out for use at the practice, however they were left in printers overnight and in unused rooms.
• Patients received effective care and treatment that met their needs. We saw that clinicians treated and cared for patients in line with current best practice guidelines and legislation.
• The practice understood the needs of its patients’ population and delivered care and treatment tailored to the individual’s needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care. Feedback from patients was very positive about care, treatment and access at this practice.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of person-centre care. There was evidence of clinical and internal audits being undertaken which demonstrated outcome improvements. However, there was no formal audit programme based on national, local and service priorities.

The overall rating for this practice was requires improvement due to concerns in providing safe and responsive care, these areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as requires improvement for providing safe services because:

• The practice did not have appropriate systems in place for the safe management of medicines. This was in respect of the monitoring of prescribed high-risk medicines and acting in accordance with patient safety alerts related to medicines.

We rated the practice as requires improvement for providing responsive services because:

• Complaints were not responded to effectively and appropriate action was not taken in response to issues raised by the complainant.
• Communication with the complainant did not include information about possible learning from the event or information about how the patient could escalate the complaint if they were dissatisfied with the outcome of the investigation.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way, in particular, management of high risk medicines.
• Establish effective systems and processes to ensure complaints are handled and responded to in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review the practice's systems for checking and monitoring equipment considering relevant guidance and ensure that all equipment is maintained, in particular, equipment held by GPs in their bags.
• Review the security of NHS prescription pads in the practice clinical areas and ensure there are systems in place to keep them safe.
• Develop and implement a protocol for the checking of prescriptions waiting to be collected to ensure they were not left without investigation for too long.
• Develop an audit programme/plan that is based on national, local and practice priorities.
• Continue to monitor and actively improve prescribing of antibiotics and hypnotics.
• Review the system and process for receiving information about non-attenders at secondary care appointments, including children.
• Continue to monitor and actively encourage the uptake of cervical screening for eligible women.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care