The Care Quality Commission
  • Doctor
  • GP practice

Archived: Oulton Medical Centre

Overall: Inadequate read more about inspection ratings

Meadow Road, Lowestoft, Suffolk, NR32 3AZ (01502) 501535

Provided and run by:
Oulton Medical Practice

All Inspections

7 October 2015

During a routine inspection

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

10 September 2015

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oulton medical centre on 10 September 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe and well led services.

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 ensure patients that needed secondary or specialist care were being appropriately referred.

Subsequent to this inspection we have undertaken a comprehensive inspection on these services and taken urgent action to cancel the registration of this provider. If the registration was still current we would have required the provider to make improvements to protect patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

2 March 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We visited Oulton Medical Centre on 2 March 2015 and carried out an announced responsive, comprehensive inspection. The provider had previously been inspected on 22 August 2014 and we were following up to see if improvements had been made.

The overall rating for this practice is inadequate. We found that the practice required improvements in order to provide a caring service. We found the practice was inadequate for providing a safe, effective, responsive and well led service.

We examined patient care across the following population groups: older people; those with long term medical conditions; mothers, babies, children and young people; working age people and those recently retired; people in vulnerable circumstances who may have poor access to primary care; and people experiencing poor mental health. We found the provider required improvement for caring for each of these population groups. They were rated as inadequate for safe, effective, responsive and well led. The concerns which led to these ratings apply to all the population groups.

Our key findings were as follows:

  • Patients told us they were involved in their care and treatment and were satisfied with the care and treatment that they received from the practice. However we were made aware of concerns by NHS England in relation to the quality of the clinical care provided.
  • Some patients were satisfied with the appointment system. Some patients reported that it was difficult to get through on the telephone and some patients were dissatisfied with the length of time they waited after arriving for their appointment. Patients at Marine Parade Surgery (branch site) told us they were not satisfied that they could not pre book appointments there and that they had arrived for an appointment, to be told it was at the other practice location.
  • The two GP partners were working hard to cover Oulton Medical Centre and the branch surgery Marine Parade Surgery. The practice had been unable to recruit a permanent GP which placed many demands on the two GP partners.
  • The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.
  • There were inadequate processes to ensure patient information was accurately coded, which meant that patients may be at risk of not receiving appropriate care and treatment. Patient correspondence was not always reviewed by a GP.
  • There were limited systems in place to monitor and ensure the safety of the service provided to patients, staff and visitors. There was a risk to staff and patients where a surgery was open for patients to attend and no clinical cover was provided.
  • The majority of staff reported feeling unsupported and had not received an induction, training or an appraisal.

There were areas of practice where the provider needs to make improvements.

The provider must:

  • Implement effective systems for the management of risks to patients and others against inappropriate or unsafe care. This should include arrangements for managing significant events, safety alerts, health and safety, fire safety and staff safety.
  • Ensure that robust arrangements are in place for the effective recruitment of staff.
  • Ensure that processes are in place for sharing the learning from significant events and complaints with all staff.
  • Ensure that there is an appropriate standard of cleanliness at the practice, with documented checks of the cleaning that is undertaken. Infection control audits need to be undertaken, with actions identified and completed. Actions from the legionella risk assessment must also be implemented.
  • Ensure that effective information governance processes are in place. This includes ensuring that that all patient correspondence is reviewed by a GP and actioned in a timely way and that clinical coding of patients is accurate.
  • Ensure that records relating to the undertaking of the regulated activity can be located promptly when required. This includes for example training records, clinical meetings, infection control audits.
  • Ensure that staff are supported, with inductions being completed for new staff and appropriate training and appraisals completed for all staff.
  • Ensure there are sufficient numbers of clinical staff when the surgery is open for patients to attend.

In addition the provider should:

  • Ensure that policies and procedures are up to date and reviewed regularly.
  • Ensure that effective processes are in place to check emergency medicines and equipment and refrigerator temperatures when the staff member who normally does this is not at work.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice