Letter from the Chief Inspector of General Practice
We rated this provider as Inadequate overall.
The key questions are rated as:
- Are services safe? – Inadequate
- Are services effective? – Inadequate
- Are services caring? – Insufficient evidence to rate
- Are services responsive? – Inadequate
- Are services well-led? – Inadequate
We undertook an announced comprehensive inspection of Doc One-Stop on 17 July 2019. This service is an Independent Health Service based on the outskirts of York, North Yorkshire and offers online consultations (via a face to face computer system), walk-in consultations, management of long-term conditions, health screening, near patient testing and electronic auriscope, stethoscope and fibreoptic camera examinations. They also dispense prescriptions on the premises. The provider registered in September 2018 and this was the first inspection of the service since its registration with the Care Quality Commission (CQC). This was carried out as part of our inspection programme, to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.
Patients register for the provider on the provider’s website and are then offered a remote appointment with a GP. Patients are also able to walk-in to the service.
We rated the practice as inadequate for providing safe services because:
- The provider had not given due regard to the health and safety of patients using the clinic; including in respect of fire safety, the calibration of medical equipment, legionella checks, electrical safety and emergency procedures.
- Staff had not been given guidance or training on identifying deteriorating or acutely unwell patients. There was no evidence that they were aware of actions to take in respect of such patients.
- The practice did not have appropriate systems in place for the safe management of infection, prevention and control.
- The practice did not have a system in place to learn and make improvements when things went wrong.
- Recruitment procedures at the clinic did not keep people safe
We rated the practice as inadequate for providing effective services because:
- There was no monitoring of the outcomes of care and treatment.
- The service was unable to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
- The service was unable to show that it always obtained consent to care and treatment.
We were unable to rate the caring domain as the service had only treated six patients and patient data was not available to us on the day of the inspection.
We rated the practice as inadequate for providing responsive services because:
- There was limited information on the provider website regarding fees and the information regarding services available was not clear.
- We were unable to assess the providers processes for consent to care and treatment as clinical records were not available.
- We saw no evidence of consultation with staff or patients with regard to service improvements.
- There were no systems in place for provider engagement with the local and wider NHS to ensure actions are in line with national and local priorities.
- Translation services were not available.
We rated the practice as inadequate for providing well-led services because:
- Leaders could not demonstrate that they had the capacity and skills to deliver high quality, sustainable care.
- The service did not have a clear vision, or a credible strategy.
- The overall governance arrangements were ineffective. The service did not have clear and effective processes for managing risks, issues and performance.
- The service did not always act on appropriate and accurate information.
- We saw little evidence of systems and processes for learning, continuous improvement and innovation.
- The provider and the registered manager demonstrated a lack of insight and oversight as to the requirements of managing the work to be performed
We found the service to be in breach of Regulation 12 Safe care and treatment, Regulation 17 Good governance and Regulation 18 Staffing of the Health and Social Care Act 2008.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure that care and treatment is provided in a safe way.
- Ensure sufficient numbers of skilled and experienced staff are employed at the practice to deliver safe care and treatment.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
(Please see the specific details on action required at the end of this report).
I am placing this service in special measures. We are taking action in line with our enforcement procedures and have urgently suspended the registration of the provider with the Care Quality Commission. The provider has 28 days to appeal this decision.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Providers and
Integrated Care