Albany Practice

We carried out an announced comprehensive inspection at Albany Practice on 24 September and 14 October 2020.

This report was created as part of a pilot which looked at new and innovative ways of fulfilling CQC’s regulatory obligations and responding to risk in light of the Covid-19 pandemic. This was conducted with the consent of the provider. We requested information from the provider on 11 September 2020, undertook a remote clinical records review and desk-based inspection on 24 September, and a short on-site visit at the practice premises on 14 October 2020. As part of the desk-based inspection a GP specialist advisor and a member of the CQC medicines team spoke with the Lead GP and two clinical pharmacists by telephone and we reviewed documentary evidence submitted by the practice.

The practice was previously inspected on 09 October 2019. Following this inspection, the practice was rated requires improvement overall and in all key questions and patient population groups. We issued requirement notices for breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance).

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 inadequate for providing safe services because:

• The practice did not have clear systems and processes to keep patients safe
• The practice did not have appropriate systems in place for the safe management of medicines, including those which require additional monitoring
• Safeguarding systems and processes including training for staff
• Recruitment checks
• Not all staff had been given guidance on identifying deteriorating or acutely unwell patients
• The practice did not learn and make improvements when things went wrong

We found the provider had made some improvements regarding:

• The management of medicines used to treat auto immune conditions
• Emergency medicines and equipment
• Cold chain management
• Infection prevention and control
• A safe system to monitor uncollected prescriptions.
• The management of patient group directions (PGDs).

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

• The practice was unable to show that clinical staff had the skills, knowledge and experience to carry out their roles
• Clinical supervision for staff
• Appraisals for clinical staff

These inadequate areas impacted all population groups and so we have rated all population groups as inadequate.

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

• There was a lack of effective action to address deteriorating results in the national GP patient survey indicators, which had deteriorated since our last inspection.
• Patients were not always given appropriate information in a timely way.

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

• There was a lack of effective action to address deteriorating results in the national GP patient survey indicators, which had deteriorated since our last inspection and were considerably below local and national averages.
• We did not see evidence of a complaints policy or that complaints were used to drive continuous learning and improvement.

These inadequate areas impacted all population groups and so we have rated all population groups as inadequate.

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

• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• 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).

The areas where the provider should make improvements are:

• Continue to undertake regular fire drills in accordance with the legislation.
• Continue to maintain oversight regarding risk assessments and follow up action points undertaken by property services.
• Continue to undertake and document regular internal infection prevention and control audits.

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