Archived: Phoenix Medical Centre

We carried out a comprehensive inspection of Phoenix Medical Centre 17 October 2019 as part of our inspection programme. The practice was given an overall rating of inadequate and placed in special measures. The domain ratings were:

Safe - Requires Improvement

Effective – Inadequate

Caring – Good

Responsive-Good

Well-led- Inadequate

On 14 November 2019 warning notices were issued in respect of Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Good Governance.

This inspection of Phoenix Medical Centre carried out on 7 January 2020 was to check the progress made with the warning notices and we found improvements had been made in all the required areas.

The rating of ‘inadequate’ awarded to the practice following our full comprehensive inspection on 17 October 2019 remains unchanged and the practice remains in special measures. A further full inspection of the service will take place within six months of the original report being published (10 December 2019) and their rating revised if appropriate.

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.

We carried out an announced comprehensive inspection at Phoenix Medical Centre on 17 October 2019 as part of our inspection programme.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 31 October 2018.

This inspection looked at the following key questions safe; effective; responsive; caring and well-led.

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.

We rated the practice as requires improvement for providing safe services because:

• The practice did not use clear systems and robust processes to keep children at risk safe.
• The practice did not always complete robust investigations into incidents to ensure there was sufficient learning when things went wrong and information about incidents and investigations was not always shared appropriately.

However, since the previous inspection:

• Receptionists had completed sepsis training and were aware of the actions to take for an acutely unwell patient.
• Steps had been taken to improve cleanliness and ensure infection control and prevention processes were robust. The clinic room used for minor surgery (knee injections) had been refurbished to meet best practice standards.
• The provider had conducted a control of substances hazardous to health risk assessment for all items used at the practice and the required safety schedules were on file.
• The provider had started to use governance processes for example, a diary reminder for when equipment should be calibrated. It was noted that this could also be beneficial for managing other aspects of the service for example all training; policy reviews; staff validation or registration checks.
• The practice had some appropriate systems in place for the safe management of medicines however, systems for managing uncollected prescriptions needed to be strengthened.

We rated the practice as inadequate for providing effective services because:

• The provider was not aware of performance indicators which suggested their performance was trending downwards and significantly below national targets.
• Audits were not always used to identify how the services outcomes could be improved.
• The system in place for mentoring and appraising medical and nursing staff needed to be strengthened to ensure staff were supported to maintain and attain the skills and experiences needed to carry out their roles effectively.
• The provider did not have a system in place to ensure patients were routinely provided with a copy of their plans of care to ensure they had information about how to manage their condition as needed.

These areas affected the population groups: older people and people whose circumstances made them vulnerable we as rated as requires improvement; families, children and young people and working age people (including those recently retired and students) we rated as inadequate. However, people experiencing poor mental health we rated as good.

We rated the practice as inadequate for providing well-led services because:

• While the practice had made some improvements since our inspection on 31 October 2018, it had not appropriately addressed the Requirement Notice in relation to developing systems and processes to improve the quality and safety of the service and we found ongoing concerns about governance systems which put patients at risk.
• The overall governance arrangements were ineffective. The practice culture did not effectively support high quality sustainable care in that clinical oversight in that appraisal system for nursing staff needed to be strengthened; and the responsibility of all staff involved was not always considered when incidents were investigated.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on information made available.
• Key communication systems needed strengthening.
• The appraisal and mentoring arrangements for key members of staff needed to be strengthened.
• Systems were not in place to ensure training for long-term agency staff was up-to-date.
• The practice did not have an audit plan to review the quality and performance of the service and identify areas of improvement and development.

We rated the practice as good for providing caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The practice had taken steps to involve patients and keep them informed of future plans.

The areas where the provider must make improvements are:

• Ensure process are developed to ensure child protection information is available to all relevant stakeholders.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure patients are offered information about their care and treatment which reflects their needs and their preferences.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Put a system in place to ensure revalidation and professional registration dates are not overlooked.

• Put a risk assessment in place for staff commencing prior to receipt of DBS status.
• Introduce a system to ensure all training is kept up to date.

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 act 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