All inspections: The Park Medical Centre

We carried out an announced inspection at The Park Medical Centre on 28 February & 3 March 2022. Overall, the practice is rated as Good.

Safe - Good

Effective – Requires Improvement

Caring - Good

Responsive - Good

Well-led - Good

Following our previous inspection on 30 June 2021, the practice was rated inadequate overall and in the safe, effective and well-led key questions; the practice was rated good in the caring and responsive key questions.

The full reports for previous inspections can be found by selecting the “all reports” link for The Park Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection;

The practice had been previously placed in special measures on 30 June 2021, the practice was subsequently inspected on 25 November 2021 to ensure that warning notices issued in relation to regulation 12 (safe care and treatment) and 17 (good governance) at the previous inspection had been complied with. In November 2021 we found improvements had been made, however further improvements were still needed. We were provided with action plans detailing how they were going to make the required improvements throughout this process. This inspection was to check the improvements made to date and to update the practice’s rating.

How we carried out the inspection;

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included;

Conducting staff interviews using video conferencing
Completing clinical searches on the practice’s patient records system and discussing findings with the provider
Reviewing patient records to identify issues and clarify actions taken by the provider
Requesting evidence from the provider
A short site visit

Our findings;

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 Good overall and in all key questions except the Effective key question, which was rated Requires Improvement.

We found that:

The practice was rated good for providing safe services because, they had made significant improvements to safety systems and had embedded them to the point where they had a positive effect on outcomes for patients. Records we viewed illustrated safe working and clinical practice.
The practice was rated requires improvement for providing effective services because, although they were able to demonstrate progress had been made from the previous inspections, they were as yet unable to demonstrate that cervical screening and childhood immunisation were in line with targets. They had developed plans and had taken action to address areas of quality assurance and clinical performance, whilst acknowledging the need to continue improvements in childhood immunisations and cervical screening uptake.
The practice was rated good for providing caring services because we found that patient satisfaction was generally high, and the practice had continued to offer a caring service throughout the pandemic.
The practice was rated good for providing responsive services because they had been proactive in trying to address lower patient satisfaction in relation to telephone access and had taken actions to address this including installing a new telephone system.
The practice was rated good for providing well-led service because we found that the practice had continued to build on improvements in all areas and had established systems and processes that had been embedded.
The practice had adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic and continued to take sensible precautions in relation to patients accessing the practice building safely.

Whilst we found no breaches of regulations, the provider should:

Reduce prescribing in areas of antibiotics, hypnotics, pain relief and psychotropic medicines.
Establish formal supervision processes for long term locum staff and visiting allied professionals.
Take further action to increase uptake of childhood immunisations and cervical screening in line with local and national targets.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced inspection at The Park Medical Centre on 28 and 30 June 2021.

The practice was given an overall rating of Inadequate with the following domain ratings:

Safe – Inadequate

Effective – Good

Caring – Good

Responsive – Inadequate

Well-led – Inadequate

Following this inspection warning notices were issued in respect of breaches to Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (safe care and treatment) and Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (good governance).

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Park Medical Centre on our website at www.cqc.org.uk

On 23 and 25 November 2021 we undertook a focused inspection to check that the practice had met the legal requirements of the warning notices. We found:

Improvements had been made in a number of areas, including non-clinical risk management, patient backlogs in relation to monitoring and systems to ensure staff had the training and knowledge to complete their roles.
The practice was working through an action plan with the support of the CCG’s pharmacist to implement further improvements around medicines management.
Governance arrangements had not yet been fully formed or embedded but were beginning to be re-established to facilitate improvements.
Clinical oversight and leadership remained incohesive and clinical risk or quality improvement activity had not always been effectively considered or implemented.
The provider had increased nursing capacity by recently recruiting new nursing staff, as well as an additional health care assistant to support them. However, these new staff members had not yet been in post long enough for their work to be reflected in patient outcomes such as improved screening uptake rates.

While we saw improvements had been made by the provider, some gaps still remained. Therefore, we found the provider had partially complied with the warning notices issued following the previous inspection.

The rating of inadequate awarded to the practice following our full comprehensive inspection on 28 and 30 June 2021 remains unchanged.

We will undertake a further full comprehensive inspection of the practice in the near future in line with our inspection methodology in order to further monitor any improvements made by the provider and to update the practice’s rating as necessary.

Details of our findings and the evidence supporting them 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 inspection at The Park Medical Centre between the 28 and 30 June 2021. Overall, the practice is rated as Inadequate.

Safe - Inadequate

Effective - Inadequate

Caring - Good

Responsive – Good

Well-led - Inadequate

Following our previous inspection on 17 October 2017, the practice was rated Good overall and for all key questions and all population groups.

We inspected all key questions to ensure that services delivered by the provider were safe, effective, caring, responsive and well-led.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Park Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection.

This inspection was a comprehensive inspection carried out due to information of concern that we received.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included;

Conducting staff interviews using video conferencing
Completing clinical searches on the practice’s patient records system and discussing findings with the provider
Reviewing patient records to identify issues and clarify actions taken by the provider
Requesting evidence from the provider
A short site visit

Our findings

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 and inadequate for all population groups.

We found that:

The safe key question was rated inadequate because there were safety concerns identified and systems in place to manage risks to patients and throughout the practice were generally ineffective. We saw monitoring of high-risk medicines was not always appropriate. Prescribing of medicines that were subject to guidance such as hypnotics, antibiotics and pain relief were higher than averages without appropriate oversight. The management of safety alerts and the assessment and consideration of risk was ineffective. Guidance to help staff to identify and take appropriate action in emergency situations were not always effective or absent.
The effective key question was rated inadequate because we found that in chronic disease management, performance was significantly lower than local and national averages. Quality improvement activity was limited and ineffective; staffing arrangements were not sufficient.
The caring key question was rated good because patient satisfaction in relation to the caring key question was higher than local and national averages.
The responsive key question was rated good because although patient satisfaction was low in some areas, the practice had taken some measures to address these, given the restrictions of COVID-19. Complaint procedures were in-line with recognised guidance and we saw information available to help patients complain.
The practice was rated inadequate for providing well-led services because overall leadership and oversight were ineffective or absent and arrangements in place to ensure learning when things went wrong and to drive improvement was limited.
The practice adjusted how it delivered services to meet infection control restrictions guidance during the COVID-19 pandemic.

We found that two regulations were breached. The provider must:

Ensure care and treatment is provided in a safe way to patients.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

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.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We previously inspected The Park Medical Centre in December 2016 and the practice was rated as requires improvement overall. We found there were gaps in responding to significant events, the assessment and management of risks including staffing and that governance arrangements were not comprehensive. The full comprehensive report on December 2016 inspection can be found by selecting the ‘all reports’ link for The Park Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 17 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 8 December 2016. Overall the practice is now rated as good.

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

Systems to recognise, record, and respond to significant events had improved and these were supported by an incident policy. Evidence was available that demonstrated outcomes and learning from significant events and complaints were shared.
We identified previously a number of areas of potential risk to both patients and staff including the lack of risk assessments for the building, legionella and the Control of Substances Hazardous to Health (COSHH). Evidence at this inspection demonstrated that safe effective systems had been implemented to address these areas.
Appropriate recruitment checks were now in place for all staff, including locum GPs. Staff had the skills, knowledge and experience to deliver effective care and treatment.
Systems to ensure medicines stored at the practice were in date were implemented and the use of prescription paper was monitored.
Governance arrangement had improved with up to date policies and procedures available to all staff on a shared drive.
Locum GPs had access to the practice policies and procedures and a Locum information pack was available in paper and electronic format.
Information about services and how to complain was available and easy to understand. The practice reviewed complaints at team meetings.
Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

The areas where the provider should make improvement are:

Formally record a business plan to monitor the practice’s effectiveness and achievement in meeting its objectives, including a strategy to improve performance in the Quality and Outcomes Framework and a programme of clinical audit and re-audit.
Continue to promote the patient participation group for the practice.
Continue efforts to identify and support patients who are also carers.
Make the practice’s complaint form readily available to patients.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Park Medical Centre on 8 December 2016. Overall the practice is rated as requires improvement.

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

The system for reporting and recording significant events was not embedded.
Risks to patients were not always effectively assessed and well managed. For example, systems were not in place to ensure the Control of Substances Hazardous to Health (COSHH) regulations are being adhered to and there was no risk assessment for the building.Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
The practice had good policies for the recruitment of staff. However, did not always adhere to these as we found gaps in personnel files.
Information about services and how to complain was available and easy to understand. However, there was no evidence of actions being implemented as a result of complaints and concerns.
Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
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 good facilities and was well equipped to treat patients and meet their needs.
There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

Ensure the recruitment arrangements include all necessary employment checks for all staff employed by the practice.
Ensure the arrangements for identifying, recording and managing risks and implementing the mitigating actions are fully embedded.
Ensure practice specific policies are implemented and available for all the required areas and locum GPs can access the required policies.
Ensure all medicines are maintained within the expiry dates.
Ensure A programme of continuous improvement and audit is undertaken.

In addition the provider should:

Maintain evidence of staff undertaking induction.
Have processes in place to audit the use of prescription papers.
Evidence any actions being taken to ensure the issues raised in the complaints do not reoccur.
Continue to identify, support patients who are also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

We visited The Park Medical Centre in September 2013 and had concerns about the safety and suitability of the premises. We were also concerned that pre-employment checks in respect of staff employed at the practice had not been taken up.

During our follow up inspection on the 30 January 2014 we found that people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises because the registered provider had taken action to ensure the premises were secure and that appropriate fire safety checks were in place.

We found that the registered provider was now operating a robust recruitment process and this ensured that suitable staff were employed at the practice.

We talked with four patients who had attended appointments on the day of our visit. We also talked with the three doctors, the practice nurse, two receptionists and the practice manager.

One patient said: "I like this group of doctors." Another patient described one of the doctors as "the best doctor in the world".

The practice worked on the basis that implied consent was given for routine examinations, but used written consent forms for minor surgical procedures. We found that staff had been trained to an appropriate level in safeguarding and knew how to report any concerns.

We found that the premises were well maintained and suitable for their use as a doctors' surgery. However, we found that the tenant of the flat upstairs had access to the surgery at any time. We considered that the provider was not compliant with the regulation relating to security of the premises.

We found that The Park Medical Centre could not demonstrate that it carried out effective recruitment processes. Therefore the provider was not compliant with the relevant regulation.

We found that there were adequate systems for monitoring the quality of the service, but that the system of recording complaints could be improved.

The Park Medical Centre

All Inspections

3 March 2022

During a routine inspection

25 November 2021

During an inspection looking at part of the service

30 June 2021

During a routine inspection

17 October 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)

8 December 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)

30 January 2014

During an inspection in response to concerns

24 September 2013

During a routine inspection