Letter from the Chief Inspector of General Practice
We previously inspected Bredbury Medical Centre in October 2015 and the practice was rated as requiring improvement overall. We found there were gaps in assessment and management of risks and that governance arrangements were not comprehensive. We carried out a further announced comprehensive inspection at the practice on 8 November 2016. Overall the practice is now rated as inadequate, as sufficient improvements have not been made and there are continued areas of concern.
Our key findings across all the areas we inspected were as follows:
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The practice had not undertaken the key action points it had said it would in order to improve following the previous inspection.
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Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment and actions identified to address concerns with infection control practice had not been taken.There were key gaps in risk assessment documentation in such areas as fire safety and legionella.
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Processes around medicines management were not comprehensive to ensure safety, for example there was no system in place to monitor blank prescriptions.
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There was limited evidence of learning and sharing outcomes with staff following the analysis of significant events.
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There was some evidence of clinical audit demonstrating quality improvement.
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While the GPs were able to discuss areas of weakness in the practice’s performance, they did not describe any action being put in place to address them.
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Patients were generally positive about their interactions with staff and said they were treated with compassion and dignity.
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There were continued gaps in the practice’s governance arrangements. There were some key gaps in policy guidance and not all staff were aware of their location. We also found evidence indicating that the practice did not consistently follow its own documented policies and procedures.
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There was a lack of managerial oversight of staff training which had resulted in key omissions, for example only two staff had received fire safety training.
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Learning from complaints was not consistently shared and one patient expressed dissatisfaction with how a verbal complaint they had raised had been handled by the practice.
The areas where the provider must make improvements are:
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Introduce more comprehensive processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.
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Take action to address identified concerns with infection prevention and control practice.
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Improve systems around medicines management so that blank prescriptions are logged and their location monitored and patient group directions available to staff are appropriately signed to demonstrate authorisation.
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Ensure staff training is undertaken and appropriately managed to ensure all staff have completed training and have the skills and qualifications to carry out their roles.
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Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.
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Provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
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Ensure the complaints policy is followed in practice when handling patient’s concerns and complaints.
The areas where the provider should make improvement are:
- Undertake activity to engage patients further in providing feedback on services offered.
- Continue efforts to identify patients who have caring responsibilities in order to facilitate their access to appropriate support.
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