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Ryalls Park Medical Centre - Yeovil Inadequate

Reports


Inspection carried out on 5 Nov 2019

During an inspection to make sure that the improvements required had been made

Previously we carried out an announced comprehensive inspection on 1 and 25 July 2019.

We served warning notices to the provider for Regulation 17 Good governance and Regulation 12 Safe care and treatment of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the quality of care they are responsible for fell below expected standards and legal requirements. Following our inspections in July 2019 the practice was rated as inadequate overall and placed into special measures.

We carried out an announced, focused follow-up inspection at Ryalls Park Medical Centre on 5 November 2019 to confirm that the practice had met the legal requirements in relation to the warning notices served after our previous inspections in July 2019. This report covers our findings in relation to those warning notices only.

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.

At this inspection we found that governance systems were not effective such that the provider had not fully assessed addressed the concerns identified previously. We have served a further Warning Notice in relation to Regulation 17, Good Governance of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In relation to the Warning Notice for Regulation 12, Safe care and treatment of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 we found the practice had taken some action to meet the legal requirements and the risks previously observed were reduced.

We found that:

  • Oversight of staff training had improved but was not embedded as gaps in training records remained.
  • There was no formal process to ensure the competency of non-medical prescribers.
  • Governance structures to support quality improvement were not embedded.
  • Governance structures to optimise effective document workflow were not embedded.
  • Systems to ensure appropriate and accurate medical coding was added to patient records were not effective.
  • Improvements were made in the identification and mitigation of risk relating to infection prevention and control.

The areas where the provider must make improvements are:

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

The areas where the provider should make improvements are:

  • Ensure fire alarm checks are consistently recorded.
  • Ensure emergency medicines are stored securely.
  • Ensure there are effective processes to monitor progress against the practice’s action plan.

The full report published on 30 September 2019 should be read in conjunction with this report. The practice remains in special measures until a full comprehensive inspection is carried out by the Care Quality Commission. Therefore, the overall rating remains inadequate.

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

Rosie Benneyworth

Chief Inspector of General Practice

Inspection carried out on 1 & 25 July 2019

During a routine inspection

We carried out an announced comprehensive inspection at Ryalls Park Medical Centre over two days, 1st and 25 July 2019 following an Annual Regulatory Review and as part of our inspection programme, and in response to information received in. We previously inspected this service 28 April 2016 where we rated it Good overall. However, the issues with telephone access were raised as a concern that should have been addressed by the provider following the inspection process.

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 inadequate overall, inadequate for safe, effective, responsive and well led and all of the population groups and requires improvement for the area of caring.

We found that:

  • Work was in progress to improve the support provided to patients with long term and mental health conditions.
  • The information about the immunisation status of staff was incomplete to support that staff vaccination was maintained in line with current Public Health England (PHE) guidance.
  • There were gaps in the staff training to meet patients’ needs for long-term conditions, although interim measures were in place until this was achieved.
  • General feedback from patients was staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The difficulties in patient communication with the practice and obtaining an appointment during the last 12 months had resulted in an increased number of complaints but there was evidence this was beginning to settle.
  • The practice had reviewed and put changes in place regarding how it organised and delivered services to meet patients’ needs in response to concerns and feedback. However, it was too early to fully assess that these changes were having a sustained positive impact.
  • Some changes in the practice partnership had affected the way the practice was led and managed and there was now a focus on improving and promoting the delivery of high-quality, person-centre care. However, it was too early to fully assess these changes were effective.
  • The systems for the management of the service records was not well organised but plans were in place to improve how information and records were stored and monitored.
  • The partnership had been slow to amend its registration with the CQC and about the changes in the partnership.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients with an effective programme of monitoring and support to meet their needs.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • The practice should continue with their actions regarding the necessary Disclosure and Barring checks are in place for staff who undertake chaperone duties.
  • The practice should continue to ensure staff acting as chaperones had the appropriate recruitment checks to guarantee patient safety.
  • Continue with ensuring the actions required following the fire risk assessment are completed in a timely way and that a programme of fire training is sustained.
  • The practice should sustain a programme of revisiting checks for safety alerts for high risk medicines so that patients are not missed from the monitoring systems.
  • The practice should continue to implement its plans for audits so that there is a sustained system in place.
  • The practice should continue to support staff to have the required training to meet the needs of the patients including long term conditions.
  • The practice should continue to proactively identify patients with long-term, mental health conditions and carers to provide them with appropriate support.
  • The practice should continue with improvements in its complaints handling processes so that complainant’s feel they are listened to and that improvements are put in place for communication with secondary care.

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 Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 28 April 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ryalls Park Medical Centre on 28 April 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. All these patients had received a telephone call from a health coach within three days of their admission.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP, although found it difficult to get through on the telephone. There was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

The practice held a meeting (a ‘Huddle’) twice every day, with the whole team involved. They used this time to look at current information that had been received, how it may impact on patient care and how best to address patients’ needs on the day. This information was also used to decide whether more appointments needed to be made available on the day; for forward planning of appointments; and to check any new information received against other agency records to ensure no patients were missed. Actions were agreed, patient records were updated during the meeting and information was shared with other members of the community multi-disciplinary teams.

The areas where the provider should make improvement are:

  • The practice should continue to improve telephone access . The last patient survey showed only 54% of patients said they could get through easily to the practice by phone compared to the national average of 73%.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 27 June 2014

During a routine inspection

We spoke with the practice manager about their action plan following out last inspection on 4 February 2014 which highlighted recruitment processes which fell below the required standards. The practice manager told us they reviewed their recruitment policies and had made significant changes to their processes for recruiting new staff.

The policies they provided to us were detailed and showed a clear recruitment pathway from advertising a vacancy through to post employment induction training. We saw there were sufficient checks in place to ensure robust and effective recruitment took place.

Inspection carried out on 4 February 2014

During a routine inspection

Patients were treated with consideration and respect. We spoke with six patients. One patient told us, “I’m happy with the way I’m spoken to here. I have no issues with that.”

Patients’ spoke positively about the care they received at the medical centre. One patient said, “I have nothing but praise for the place.” Another patient said, “I’m really very happy with the surgery.”

People who used the medical centre, staff and visitors were protected against the risks of unsafe or unsuitable premises.

The provider carried out a number of pre-employment checks to ensure that staff had the necessary skills and experience. However, the current system used by the medical centre did not ensure staff were of good character prior to them commencing employment.

The medical centre had suitable systems to monitor the quality of the service provided.