The Groves Medical Centre

We carried out an announced inspection at The Groves Medical Centre with a site visit on 27 October 2023, interviews with staff on 7 November 2023 and reviews of searches and patient records on 1 November 2023 and 17 November 2023.

Overall, the practice is rated as inadequate.

Safe - inadequate

Effective - requires improvement

Caring - not inspected, rating of good carried forward from previous inspection

Responsive - requires improvement

Well-led - inadequate

After we inspected the practice in May 2015, we rated it as good overall, but as requires improvement for safety, as we found gaps in the systems and processes to manage risk and learn from things that had gone wrong. The practice had addressed the issues by the time we inspected again in June 2016.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Groves Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection in line with our inspection priorities. We inspected the safe, effective, responsive, and well-led key questions.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• conducting staff interviews using video conferencing
• completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements)
• reviewing patient records to identify issues and clarify actions taken by the provider.
• requesting evidence from the provider.
• a site visit.

Our findings

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 found that:

• There were widespread gaps in safety systems and processes, including those to keep people safe, identify and manage risks, assess, prevent and control the spread of infections and safely use medicines and to learn and improve when things went wrong.
• The overall governance arrangements were ineffective. Practice leaders rolled out new governance structures in early 2023. There was a new Executive Board and 4 governance domains (Finance, People and Workforce planning, Governance and Compliance and Clinical). The governance domains were at different stages of development at the time of the inspection. Although we saw evidence of improvement in some areas, we identified weaknesses in oversight of risk that had not been addressed by the practice’s assurance systems and policies that were not implemented effectively.
• Leaders had not, when making changes to the service, identified the risks that needed to be considered or had identified the risks but had failed to establish effective means to manage them
• Some of the safety issues were identified were the same as those we told the practice to address in 2015.
• The practice was unable to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
• Patients’ needs were not always assessed, and care and treatment was not always delivered, in line with current legislation, standards and evidence-based guidance.
• The practice had not fully complied with the Accessible Information Standard.
• Reasonable adjustments were made when patients found it hard to access services. The practice had implemented an online triage system, which did not take into account previously agreed individualised adjustments when suggesting appointments. The practice had considered the risk that patients may not be willing or able to use the new system, and had arrangements in place to allow patients to continue calling or visiting the practice. Staff completing the triage tool had access to information about individualised adjustments. However the impact on patients with adjustments who were able to use the system and felt comfortable doing so was not considered, and information on this was not provided for these patients prior to implementation.
• Complaints were not consistently handled in line with national guidance.
• The practice had made changes to the service, but was not always fully monitoring the impact on the patient experience or the quality of care. The practice had introduced a new phone system and was monitoring the average wait time per week, but was not routinely reviewing the time taken for patients to get through to the practice at different times. Staff in different advanced clinical roles were seeing more patients who would traditionally have been seen by GPs, but there was insufficient oversight to ensure that the quality and safety of care was maintained
• Staff told us that they felt well-supported and enjoyed good opportunities for development. The culture was described as positive, and colleagues as friendly and helpful.

Although the practice leaders told us of plans to improve governance arrangements and showed us evidence of some individual systems that had been improved, ratings are based on evidence at the time of inspection.

We found breaches of regulations. The provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• 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.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

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.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care