The Care Quality Commission
  • Doctor
  • GP practice

Adam House Medical Centre

Overall: Requires improvement read more about inspection ratings

85-91 Derby Road, Sandiacre, Nottingham, Nottinghamshire, NG10 5HZ 0844 815 1097

Provided and run by:
Adam House Medical Centre

All Inspections

21 November 2022

During a routine inspection

We carried out an unannounced focused inspection at Adam House Medical Centre on 21 November 2022 and at the branch practice Hillside Medical Centre on 22 November 2022. Overall, the practice is rated as requires improvement.

We rated the key questions inspected as follows:

Safe - requires improvement

Effective – requires improvement

Caring - good

Responsive - good

Well-led – requires improvement

Following our previous inspection on 21 and 25 October 2021, the practice was rated requires improvement overall and for all key questions except caring, which was rated as good.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Adam House 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 and to follow up on previous breaches identified at the last inspection.

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 clinical interviews.
  • 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 ineffective systems in place for processing information relating to new patients including the summarising of new patient notes. We found hundreds of patients records awaiting action.
  • The practice had a system in place for the actioning of significant events and incidents, however we were unable to gain assurances that there was a formal process in place for shared learning to mitigate future risk.
  • The practice had been through a constant change of management in the recent months and this had impacted on systems being monitored. For example: we were unable to gain assurances that all staff files were complete and staff had the appropriate immunisation status according to their role.
  • Risk management processes were in place and we found some assessments of risks had been completed. These included fire safety and a range of health and safety assessments, however the premises risk assessment was out of date.
  • We found the premises visibly clean and tidy, but due to staff shortages within the nursing team, the practice currently had no infection control lead to ensure guidelines were being followed appropriately.
  • Patient feedback was negative in response to access and appointment availability. The practice had opened up the branch practice 2 mornings a week to increase appointments and also had employed a regular GP locum to provide further appointments.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.

We found a breach of regulation. 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.

In addition the provider should:

  • Review the current system for sharing learning of incidents and complaints
  • Continue to encourage patients to attend immunisation national screening programmes such as cervical screening.
  • Review and update the current processes for the completion of medicine reviews
  • Monitor staff training

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 Hospitals and Interim Chief Inspector of Primary Medical Services

21 October and 25 October 2021

During a routine inspection

We carried out a short announced inspection at Adam House Medical Centre on 21 and 25 October 2021. Overall, the practice is rated as requires improvement. It is rated as:

  • Requires improvement for providing safe care and treatment
  • Requires improvement for providing effective care
  • Good for caring
  • Requires improvement for providing responsive care
  • Requires improvement for well-led

Following our previous inspection on 7 January 2019, the practice was rated Good overall and for all key questions.

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

Why we carried out this inspection

This inspection was a comprehensive inspection to follow up on:

  • Concerns shared with the CQC regarding the safe care and treatment of patients and overall governance of the service.
  • Key questions safe, effective, caring, responsive and well-led.
  • Five best practice recommendations identified at our previous inspection:
  • Review the availability of risk assessments to explain the absence of some recommended emergency medicines on site.
  • Ensure that vaccine storage is maintained in line with guidance at all times.
  • Improve the identification of carers to enable this group of patients to access the care and support they need.
  • Improve the uptake of annual health reviews for patients with a learning disability.
  • Review the practice complaints policy and procedure to ensure these were in line with recognised guidance

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing and on site
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • 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 have rated this practice as Requires Improvement.

We rated the practice as requires improvement for providing safe care and treatment. This is because:

  • Not all clinicians reviewed all prescribed medicines during medicine reviews.
  • Information held in the patient records was not always appropriately electronically coded, up to date or accurate.
  • The practice did not have a system in place to demonstrate their assurance of the prescribing competence of non-medical prescribers.
  • There was a system in place for recording and acting on safety alerts, the practice had not incorporated however legacy medicine alerts into their routine clinical practice.

We rated the practice as requires improvement for providing an effective service. This was because:

  • The practice had identified backlogs of activity, for example medicine reviews, the backlog of work had impacted on the accuracy of information available to clinicians both internally and external to the practice.
  • Pathology results and letters had not always been seen and actioned in a timely manner, which had created a backlog in scanning and attaching letters to patient records. This had resulted in a patient not being prescribed the correct medicines.
  • Clinicians had not always informed patients about abnormal results and referrals to secondary care, which had caused distress to the patients concerned.
  • Patients with long-term conditions were not always offered a structured annual review to check their health and medicines needs were being met.
  • The practice did not have clear systems in place to ensure staff worked within the limits of their competency or to review their performance.

We rated the practice as good for caring. This is because:

  • Staff treated patients with kindness, respect and compassion.
  • There were systems in place to support carers.

We rated the practice as requires improvement for responsive because:

  • There was a pattern of complaints relating to access to the service and availability of appointments and difficulty with getting through to the practice by phone.
  • Due to significant staffing issues people had not always been able to access care and treatment in a timely way.
  • All the staff we spoke with on the day of the inspection considered there were not sufficient GPs available at the practice to meet patient demand and that patients had complained about the lack of available appointments provided by a GP.

We rated the practice as requires improvement for providing a well-led service. This is because:

  • Structures, processes systems to support good governance and management were not always effective.
  • Due to significant staffing and recruitment issues and the Covid-19 pandemic, the practice had not been in a position to monitor progress against the delivery of their strategic aims.
  • There was no evidence that the quality of access had been monitored or improvements made.
  • Staff we spoke with told us they enjoyed working at the practice and most felt supported in their work. They told us there had been significant staff changes and challenges. However, they told us significant improvements had been made in the leadership of the practice due to the recent recruitment of an advanced clinical practitioner, who had implemented a number of changes to improve patient care safety.
  • The impact of changes in staffing on safety and staff morale had not been risk assessed or monitored.
  • There was no evidence that formal arrangements had been developed or implemented to provide effective staff cover.

We found two 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.

Whilst we found no breaches of regulations, the provider should:

  • Complete the identified actions in the fire and infection prevention and control risk assessments. For example remove the hooks for the fire doors, and repair or replace the couches.
  • Develop an induction or competency checklist tailored to individual staff roles.
  • Increase the number of carers identified.

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

7 January 2019

During a routine inspection

We carried out an announced comprehensive inspection at Adam House Medical Centre on 7 January 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 good overall and good for all population groups.

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
  • Staff involved and treated people with compassion, kindness and respect, and involved them in decisions about their care. Patient interviews and feedback received through CQC comment cards supported our observations.
  • 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 good quality, person-centre care.
  • At our previous inspection in 2014, two areas were identified in which the provider should consider making further improvements; these related to the completion of audit cycles and formal clinical supervision for nurses. The practice had considered these points and was able to demonstrate the improvements they had made when we inspected in January 2019.

We saw the following area of outstanding practice:

  • The practice employed a hospital-based diabetes nurse specialist for two sessions each week. The nurse focused on achieving good outcomes for patients with complex needs and engaging them with their treatment regimes. The impact was seen by low exception reporting rates for patients with diabetes, which were more than half below the local and national exception reporting percentages.

In addition, the provider should:

  • Review the availability of risk assessments to explain the absence of some recommended emergency medicines on site.
  • Ensure that vaccine storage is maintained in line with guidance at all times.
  • Improve the identification of carers to enable this group of patients to access the care and support they need.
  • Improve the uptake of annual health reviews for patients with a learning disability.
  • Review the practice complaints policy and procedure to ensure these were in line with recognised guidance

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

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

28 January 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We inspected this practice on 28 January 2015 as part of our new comprehensive inspection programme. This is the first time we have inspected this practice.

The overall rating for this practice is good. We found the practice to be good in the safe, effective, caring responsive and well led domains. We found the practice provided good care to people with long term conditions, families, children and young people and people in vulnerable circumstances, older people, working age people and people experiencing poor mental health.

Our key findings were as follows:

  • Patients told us they were satisfied with the appointments system and told they could see a GP when they needed to.
  • Patients were kept safe from the risk and spread of infection as the provider had carried out audits and acted on their findings
  • Patients were treated with dignity and respect and spoken to in a friendly manner by all staff
  • Systems were in place to keep patients safe by assessing risk and taking steps to reduce this. We saw evidence of learning from previous incidents.
  • Patients, their relatives and carers were involved in all aspects of treatment and their opinions were listened to and acted upon.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • The practice had a very active and involved Patient Participation Group (PPG) carried out all patient surveys which included patient experience of individual clinicians

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • Ensure that all audits cycles are completed by ensuring a second cycle is carried out to demonstrate whether improvements had been made following re-audit.
  • Clinical supervision should be provided for all clinical staff including nurses to enable and support their continuous professional development.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice