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Inspection carried out on 7 May 2019 to 7 May 2019

During a routine inspection

We carried out an announced comprehensive inspection at The Modern Medical Centre on 7 May 2019.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 17 September 2018. Where the practice was found requires improvement overall and for the domains, safe and well led and for all of the population groups children and families and good for the domains effective, caring and responsive and all the remaining populations.

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,
  • information from the provider, patients, the public and other organisations.

We have rated this practice as good for providing a good service for all of the population groups. This is because: -

  • The practice has complied with the breaches of regulation found during the inspection of 17 September 2018.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice had clear systems, practices and processes to keep people safeguarded from abuse.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • The practice had improved access for patients to the practice.
  • Patients received effective care and treatment that met their needs.
  • Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
  • Complaints were listened and responded to and used to improve the quality of care.
  • There was compassionate, inclusive and effective leadership at all levels.

The areas where the provider should make improvements are:

  • Review the protocol and monitoring for summarising patients records to ensure all are completed in a timely manner.
  • Review staff training to incorporate mental capacity act and mental health act training.
  • Identify further carers and provide the appropriate support.
  • Continue to improve the childhood immunisation uptake rates to ensure they are line with the World Health Organisation (WHO) targets.

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.

Inspection carried out on 17 September to 17 September 2018

During a routine inspection

This practice is rated as requires improvement overall.

(Previous rating 30 June 2017 CQC the rating was good overall and for all the key questions (with the exception of responsive)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement.

We carried out an announced comprehensive inspection at Modern Medical Centre on 17 September 2018. As part of our inspection programme and to follow up the finding of requires improvement in the responsive domain at the inspection on the 30 June 2017.

At this inspection we found:

On the day of the inspection staff could tell us about the actions they had carried out but they were sometimes unable to provide us with the written evidence of their actions. This meant that there were gaps in the systems and processes for safeguarding, medicines, and infection control which did not always mitigate and prevent risks to patients or support good governance. However, following the inspection the practice was responsive and responded within 48 hours to our concerns and has put into place new systems and processes to ensure accurate recording and to minimise the risks to patients.

  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The practice had responded to the patient feedback.
  • The provider supported a 39-bed residential care home that had gained platinum accreditation for End of Life Care Framework. The home manager explained this had improved the end of life care for many of their residents over the last six years.
  • The practice took complaints and concerns seriously and responded to them appropriately.
  • The provider had carried out clinical audits that had improved outcomes for patients.
  • Leaders at all levels were visible and approachable.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure patients are protected from abuse and improper treatment.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Review the policies and standard operating procedures to ensure that they fully reflect the services practices.
  • Review staffs training to ensure they have covered the necessary training for their roles.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice.

Inspection carried out on 30 June 2017

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Modern Medical Centre on 27 October 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 27 October 2016 inspection can be found by selecting the ‘all reports’ link for Modern Medical Centre on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 30 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 27 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • A control of substances hazardous to health (COSHH) risk assessment had been carried out and data sheets were available for all chemicals used in the practice.

  • All staff had information governance, safeguarding and infection control training and the certificates were accessible in a training folder.

  • Risks to patients were assessed and well managed, including the actions outlined in the Legionella risk assessment identified in the previous inspection.
  • There had been some improvements in patient’s satisfaction with access to appointments and getting through on the phone but survey scores were still lower than local and national averages. Patients said urgent appointments were available the same day.
  • Recruitment procedures were in place and all staff and all now had the appropriate recruitment checks as outlined in the practice policy.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice had facilities and was equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients.
  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

Ensure action is taken to improve all areas of patient satisfaction so that it is in line with national survey results, in particular with the practice’s opening hours and access to the practice by phone.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 27 October 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Modern Medical Centre on 27 October 2016. Overall, the practice is rated as requires improvement.

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

  • Risks to patients were assessed and well managed, with the exception of those related to the control of substances hazardous to health (COSHH).
  • Clinical staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, we found gaps in mandatory training for all staff including infection control, information governance, fire safety and safeguarding.
  • Patients said they found it difficult to contact the surgery by telephone and that they were not satisfied with the practice opening times. Patients said urgent appointments were available the same day.
  • Recruitment procedures were in place; however, recruitment checks were inconsistent and did not follow practice policy.
  • Information about services and how to complain was available and easy to understand. Some action had been taken to improve the quality of care as a result of complaints and concerns.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice had facilities and was equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients.
  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

  • Ensure all staff receive formal and consistent training in safeguarding, information governance and infection control relevant to their roles.
  • Ensure systems are in place to monitor repeat prescriptions.
  • Implement the actions identified in the legionella risk assessment and carry out a COSHH risk assessment.
  • Ensure action is taken to improve all areas of patient satisfaction so that it is in line with national survey results, in particular with the practice’s opening hours and access to the practice by phone.

The areas where the provider should make improvement are:

  • Ensure pre-employment checks are carried out in line practice recruitment policy.
  • Improve childhood immunisation rates for five year olds to bring in line with national averages.
  • Review systems to identify carers in the practice to ensure they receive appropriate care and support. Consider ways to support patients who are hard of hearing.
  • Maintain a record of decisions and actions arising from practice meetings and other formal meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice