Archived: The Clarence Medical Centre

Letter from the Chief Inspector of General Practice

CQC inspected the practice on 4 November 2014. We found some areas of concern and had asked the provider to make improvements.

We undertook this announced comprehensive inspection on 9 September 2015 of Clarence Medical Centre, to check whether there had been any improvements and found that whilst some of our concerns had been addressed we found overall the practice had not improved and we identified further concerns.

Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, there was no clear infection control lead and the practice had not undertaken an infection control audits since January 2014.
• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.
• There was insufficient assurance to demonstrate people received effective care and treatment. For example, QOF data for this practice showed that overall it was performing below national standards and we did not see any evidence that the practice had any systems to monitor outcomes for patients
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• Urgent appointments were usually available on the day they were requested. However patients said sometimes it was very difficult to get through to the practice when phoning to make an appointment.
• The practice had no clear leadership structure and limited formal governance arrangements.

The areas where the provider must make improvements are

• Ensure clear systems are in place for reporting and recording significant events.
• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision as we found there was an unguarded electric halogen heater in the nurse’s room which presented a serious risk to patients, especially children.
• Take action to address identified concerns with infection prevention and control practice as we found there was no clear infection control lead and no audits had been undertaken since January 2014
• Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines as we found the GPs were unfamiliar with the dangers of prescribing high risk medication.
• Ensure there are formal arrangements in place for reviewing patients with long term conditions
• Ensure clinical audits are undertaken in the practice, including completed clinical audit or quality improvement cycles.
• Ensure the GPs understand the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.
• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.

Action the provider SHOULD take to improve:

• Clarify who the safeguarding lead for the practice is and ensure all staff are aware of it.
• Develop cleaning records or schedules for the practice.

I am placing this practice in special measures. Practices 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 practice 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 vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice