Archived: Oulton Medical Centre

Updated 14 January 2016

Oulton Medical Centre, in the Great Yarmouth and Waveney Clinical Commissioning Group (CCG) area, provided a range of primary medical services to approximately 5300 registered patients living in Oulton and the surrounding villages.

They had a branch surgery called Marine Parade Surgery, which is approximately three miles away. According to Public Health England information, the patient population has a slightly lower number of patients aged under 18 compared to the practice average across England. It had a slightly higher proportion of patients aged 65 and over, aged 75 and over and aged 85 and over compared to the practice average across England. Income deprivation affecting children and older people is slightly higher than the practice average across England. A slightly lower percentage of patients had a caring responsibility and a slightly higher percentage of patients have a long standing health condition compared to the practice average across England.

There were two GP partners, one male and one female who held financial and managerial responsibility for the practice. The practice employed a GP locum for periods when the GPs were not available. A locum emergency care practitioner was also employed and worked 8am to 4pm, two days a week, under the supervision of the GP who was working that day.

There was one practice nurse who works one day per week and a health care assistant, who worked 9am until 3pm, three days a week and alternates between the sites. We were told that a further health care assistant would have begun work at the practice shortly after our inspection and would have been working three days per week.

There were also five administration/reception staff, one medical secretary and one administrator and a practice manager who had been in post for eight weeks at the time of our inspection.

The practice was open 8am to 7pm Monday to Friday, with extended hours from 7:30am on a Thursday. Appointments are available within these times. Outside of practice opening hours, patients could have accessed the GP Out of Hours service (Integrated Care 24) by calling NHS 111 service.

We previously inspected this location on 22 August 2014 and 2 March 2015 and found they were not meeting the Health and Social Care Act Regulations (2008) and the practice was placed in special measures on 23 April 2015.

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oulton Medical Centre on 7 October 2015 and a follow up unannounced visit on the 12 October 2015. We had previously inspected this practice in March 2015 when the practice was placed into special measures due to concerns across all the domains that CQC inspects. We inspected again in September 2015 after concerns were raised by NHS England regarding referral of patients to specialised care and prescribing errors. On the September inspection, we found that the practice was failing to refer patients to specialist services in a timely way, not learning from complaints and errors and failing to keep patient records adequately updated. As a result CQC issued a warning notice. The purpose of the latest two day inspection was to follow up the concerns identified in the warning notice and to see whether the practice had secured sufficient improvement for the special measures to be lifted. The practice continues to be rated as inadequate overall.

Specifically, we found the practice inadequate for providing safe, effective and well led services. It required improvement for responsive services. It was also inadequate for providing services for families, children and young people, working age people, older people, people with long standing conditions, people whose circumstances make them vulnerable and people experiencing poor mental health.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate processes were not in place to issue prescriptions and follow up patients on long term medicines to ensure these remained safe and appropriate for each patient.

• There was insufficient assurance to demonstrate people received effective care and treatment. For example reviewing people prescribed controlled drugs to ensure they were still receiving appropriate treatment. Patients were not being appropriately recalled for blood tests and to review their medication.

• Patients did not have the correct code added to their care records this demonstrated a failure to ensure that the practice and other providers could access accurate detail upon which to make judgements regarding patient care.

• Staff were not clear about their responsibilities or the process for reporting incidents, near misses and concerns and the provider could not demonstrate evidence of learning and improving services from incidents.

• The practice leadership structure was not clear; there was insufficient leadership capacity and limited formal governance arrangements to enable the provider to fulfil their responsibilities to assess and monitor the quality of the service and to identify, assess and mitigate risk.

• Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments and that it was very difficult to get through to the practice when phoning to make an appointment.

As a result of serious concerns being identified on 7 October the registration of  this provider was cancelled with immediate effect by court order on 13 October 2015  under section 30 of the Health and Social Care Act 2008.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 January 2016

The provider was rated as inadequate for providing safe, effective, caring, and responsive and well led services. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is rated as inadequate for the care of people with long-term conditions. Structured annual reviews were not undertaken to check that patients’ health and care needs were being met. Quality and outcomes framework data for patients with long term conditions was poor for example diabetes where the practice achieved 48.8% which was 40.4% below national average.

Updated 14 January 2016

The provider was rated as inadequate for providing safe, effective, caring, and responsive and well led services. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were limited systems to identify and follow up patients in this group, some who were living in disadvantaged circumstances and so were at additional risk. We also saw examples of care which some female patients described to us as oppressive. Several patients told us they had felt intimidated into treatment plans advocated by one of the GPs. Quality and outcomes framework data for cervical screening was poor, the practice achieving 74% which was 7.8% below national average.

Updated 14 January 2016

The provider was rated as inadequate for providing safe, effective, caring, and responsive and well led services. The concerns which led to these ratings apply to everyone using the practice, including this population group. The lead GPs demonstrated insufficient understanding of the needs of older people and were not attempting to improve the service for them. Services for older people were therefore reactive and there was a limited attempt to engage this patient group to improve the service. We saw evidence of prescribing errors which had put patients at potential risk of serious harm. Quality and outcomes framework data for conditions commonly found in older people was poor for example rheumatoid arthritis; the practice only achieving 83.3% which was 12.1% below national average.

Updated 14 January 2016

The provider was rated as inadequate for providing safe, effective, caring, and responsive and well led services. The concerns which led to these ratings apply to everyone using the practice, including this population group. The age profile of patients at the practice is mainly those of working age, students and the recently retired but the services available did not reflect the needs of this group due to widespread clinical errors.

Updated 14 January 2016

The provider was rated as inadequate for providing safe, effective, caring, and responsive and well led services. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice did not have a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Some staff had received training on how to care for people with mental health needs but no dementia training was available. Quality and outcomes framework data for dementia was poor, the practice only achieving 76.9% which is 17.6% below national average.

Updated 14 January 2016

The provider was rated as inadequate for providing safe, effective, caring, and responsive and well led services. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice worked with multi-disciplinary teams in the case management of vulnerable people but was not translating the notes from these meetings into patients’ notes and forming care plans. There were no examples of on-going care packages demonstrated to us as a result of the meetings.

There were examples shown to us of poor prescribing and we were told of patients having large doses of opiate medication being prescribed to them without due care and management of these addictive medicines.