We carried out an announced comprehensive inspection at Moredon Medical Centre on 9 and 12 November 2018, as part of our inspection programme. Our inspection team was led by a CQC inspector and included a GP specialist advisor.
Our judgement of the quality of care at this service is based 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.
The practice is rated as Inadequate overall.
Moredon Medical Centre entered into a partnership arrangement with Integral Medical Holdings (IMH) in June 2018. Since August 2018, Moredon Medical Centre patients have raised concerns about the services provided in relation to delayed appointment access, difficulties telephoning the practice and delayed repeat prescriptions. Patients have also made contact with the local members of parliament, the media and Healthwatch to share their experiences. The practice leadership and management team have respond to these challenges, however patients and staff we spoke with on the day of inspection, reported that concerns remained. We found there has been insufficient management infrastructure and insufficient leadership capacity and capability. There are significant concerns regarding the lack of effective governance and oversight to ensure quality and safety are not compromised.
A Warning Notice regarding the breach of the Health and Social Care Act 2008, Regulation 17, Good Governance, was served on the practice.
We concluded that:
- People’s needs were not being met by the way in which services were organised and delivered. Patients we spoke with reported significant difficulties with the appointment and telephone system and how they were not able to access care when they needed it.
- Staff did not have the information they needed to deliver safe care and treatment to patients. There was a lack of effective governance and oversight to ensure quality and safety.
We rated the practice as inadequate for providing safe and well-led services because:
- The delivery of high quality care was not assured by the leadership, governance and culture of the practice.
- The was no lead for safeguarding people from harm or the prevention and detection of infection.
- Patient referrals were not processed in a timely way.
- When incidents did happen, the practice did not consistently learn from them or improve their processes.
- The practice did not have a comprehensive programme of quality improvement activity and did not consistently review the effectiveness and appropriateness of the care provided.
- Some health and safety and risk management legal requirements were not met.
- Patients reported that the appointment system was not easy to use and that there were sometimes difficulties in accessing the practice by telephone. Repeat prescription requests were not always processed effectively, which led to delays in patients obtaining their medicines.
- Some staff did not receive appropriate support, training, professional development, supervision and appraisal.
- Staff records did not include all information relevant to their employment, and current and existing staff records were not recorded on the new IT system. The practice could not provide evidence that staff had received up to date vaccinations.
- Blank prescription pads were not stored securely at all times.
- Cancer screening and diagnosis rates were low compared to local and national averages.
- QOF scores for the percentage of patients experiencing mental health problems, who had a record of alcohol consumption, were low compared to local and national averages.
- The practice did not have clear and effective processes for managing risks, issues and performance. There were no formal and recorded risk assessments with regards to health and safety. There was no infection prevention and control audit, and a fire risk assessment had not been conducted since 2015.
- The overall governance arrangements were ineffective.
- The practice did not have clear systems, practices and processes to keep people safe and safeguarded from harm.
The areas where the provider must make improvements are:
- Ensure care and treatment are provided in a safe way for service users.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- Ensure staff employed are suitably qualified to carry out their role.
- Ensure recruitment procedures are established and operated effectively.
The areas where the provider should make improvements are:
- Review arrangements for blank prescription pads, to ensure these are stored safely and securely.
- Review arrangements for cancer screening and diagnosis.
- Review arrangements for monitoring the physical health of people with mental illness, severe mental illness, and personality disorder.
- Review arrangements for routine referral letters, to ensure these are processed more quickly.
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.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice