All inspections: Brown Clee Medical Centre

We carried out a review of the data available to us about Brown Clee Medical Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Brown Clee Medical Centre, you can give feedback on this service.

We carried out an announced focused inspection at Brown Clee Medical Centre on 16 August 2021. The practice is rated Good.

The ratings for each key question are as follows:

Safe - Good

Effective – Good

Caring - Outstanding

Responsive - Outstanding

Well-led – Requires Improvement

We carried over the ratings from the last inspection for the caring and responsive key questions.

Following our previous inspection on 30 July 2019, the practice was rated Requires Improvement overall and for key questions safe and well-led. The practice was rated Good for providing effective services and outstanding for providing caring and responsive services.

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

Why we carried out this inspection.

This inspection was a focused inspection to follow up on a breach of Regulation 12 Health and Social Care Act 2208 (Regulated Activities) Regulations 2014, Safe care and treatment.

This was because:

Not all staff had received up-to-date essential training.
The safeguarding policy was not local to the practice and did not reflect current guidance.
There was no documented risk assessment for the security of medicines held in the dispensaries.
A system to track prescription stationery and security of prescriptions throughout the main location had not been implemented.
A controlled drugs cabinet or register was not available at the branch location for the storage of these medicines whilst awaiting collection.
The controlled drug cabinet at the main location did not meet the required standard.
A risk assessment had not been undertaken in relation to key holding responsibilities for dispensing staff.
The controlled drug standing operating procedures (SOP) did not provide dispensing staff with clear guidance on the management and dispensing of these medicines.

At the inspection in August 2021 we found that the provider had satisfied the requirements of the regulation.

How we carried out the inspection/review

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
A telephone call with a representative of the Patient Participation Group

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 good for providing safe and effective services and requires improvement for providing well-led services. We rated all population groups as good.

We found that:

Safety systems and processes to keep people safe and safeguarded from abuse had improved.
The management and dispensing of medicines had been reviewed and improved.
Patients received effective care and treatment that met their needs.
Staff dealt with patients with kindness and respect and involved them in decisions about their care.
The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
Staff understood their role and responsibilities in providing positive health outcomes for patients.
Structures, processes systems to support good governance and management had improved overall but were not always effective.
The practice continued to have very high patient satisfaction levels. The Practice achieved significantly higher results across all areas within the GP patient survey, compared to local and national averages. For example, 99% of respondents responded positively to their overall experience of this GP practice. A 100% of respondents responded positively to how easy it was to get through to the Practice on the phone.

The areas where the provider should make improvements are:

Review and strengthen governance arrangements.
Ensure the required staff recruitment checks are completed.
Develop a system to ensure the immunisation status and registration of clinical staff are checked and regularly monitored.
Ensure staff induction is documented.

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 General Practice

We carried out an announced focused inspection at Brown Clee Medical Centre on 30 July 2019. We decided to undertake an inspection of this service following our annual review of the information available to us and due to the timescale of the previous inspection. Within our new methodology we decided to inspect whether the practice was providing safe, effective, and well-led services. Information available to us did not indicate that the quality of care had changed in relation to the key questions caring and responsive. As a result, the ratings for caring and responsive have been carried forward to contribute to the overall rating for this practice. 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 previously carried out an inspection of Brown Clee Medical Centre on 10 June 2015. The practice was rated outstanding for providing caring and responsive services and good for providing safe, effective and well-led services. No breach of legal requirement was found, and two good practice recommendations were made. We saw these had since been met. The report on the June 2015 inspection can be found by selecting the ‘all reports’ link for Brown Clee Medical Centre on our website at .

We have rated this practice as requires improvement overall and outstanding for the following population groups: Older people, Families, children and young people and people whose circumstances may make them vulnerable. Other population groups were rated as good.

The practice is rated as requires improvement for providing safe services because:

At the time of the inspection the management of safety systems and processes to keep people safe and safeguarded from abuse was not embedded. Not all staff had received training in safeguarding and the safeguarding policy was not local to the practice and did not reflect updated categories of abuse.
Not all staff had received or were up to date with training in safe working practices.
A basic environmental and health and safety risk assessment had been undertaken, however, an action plan had not been developed to identify the specific action to be taken, by whom and the date of completion. No fire risk assessment had been undertaken and fire notices displayed around the practice did not include the fire assembly point. There were no designated fire marshals appointed.
Although the provider had considered the risk, at the time of the inspection there was no documented risk assessment for the security of medicines held in the dispensaries. A system to track prescription stationery and security of prescriptions throughout the main location had not been implemented. A controlled drugs cabinet or register was not available at the branch location for the storage of these medicines whilst awaiting collection. The controlled drug cabinet at the main location did not meet the required standard. A risk assessment had not been undertaken in relation to key holding responsibilities for dispensing staff. The controlled drug standing operating procedures (SOP) did not provide dispensing staff with clear guidance on the management and dispensing of these medicines.

Within 48 hours of the inspection the provider sent us an action plan in response to the immediate concerns that we identified on the day of the inspection

We rated the practice good for providing effective services because:

The practice understood the needs of its population and tailored services in response to those needs.
Staff were consistent and proactive in helping patients to live healthier lives.
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.
Audits were undertaken although these were limited. Leaders fully acknowledged this at the time of the inspection and recognised the need to formalise audits to demonstrate quality improvement.

We rated the practice requires improvement for providing a well-led service because:

The provider had governance structures and systems in place however, these did not ensure effective governance. For example, at the time of the inspection there was a lack of oversight of the management of risks.
The practice had a number of policies and procedures to govern activity. However, not all policies were readily accessible or reviewed and updated.
Not all the information we requested was available on the day of the inspection. For example, information in relation to health and safety.
Staff felt supported in their work and valued by the management team. They were proud to work at the practice and comfortable to raise concerns.
Leaders were visible, approachable and understood the strengths and challenges relating to the quality and future of services.
The practice had a well-established patient participation group (PPG) who were very active in representing the views of patients and worked closely with their local community. They told us they felt extremely valued and empowered by practice leaders. With the support of the practice the PPG had helped set up a wide range of community initiatives.
We received overwhelming positive comments from patients and managers at local care and nursing homes in relation to their experiences of the quality of care and treatment provided by the practice. This was also reflective of reviews posted on an NHS website and in an independent survey the practice had commissioned in July 2019.

We saw the following outstanding practice:

The practice was consistently rated very highly in the National GP surveys. In 2018 the practice was rated first in the top ten best rated GP surgeries in England for providing the best overall experience and were featured in a national newspaper. In the 2019 National GP survey the practice scored higher than their CCG average and the national average in every question. One hundred percent of respondents responded positively to how it was to get through to the practice on the phone, with 98% of patients responding positively to their overall experience of making an appointment and 99% described their overall experience as good.

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

Ensure care and treatment is provided in a safe way to patients

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

Develop a documented business and succession plan.
Provide staff with additional training on the use of GP TeamNet so they are confident in navigating the system.
Develop a systematic programme of clinical audit.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Brown Clee Medical Centre is comprised of two locations - the main practice at Ditton Priors, Bridgnorth, and a branch location in Stottesdon. We carried out an announced comprehensive inspection at Ditton Priors and visited the dispensary at Stottesdon on 10 June 2015. Overall Brown Clee Medical Centre is rated as outstanding.

Specifically, we found the practice to be outstanding in caring and responsive and good for providing safe, effective, and well-led services. It was also outstanding in providing caring and responsive services for older people, families, children and young people and people whose circumstances make them vulnerable.

Our key findings were as follows:

Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they met patients’ needs.
The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
The practice had a clear vision which had quality and safety as its top priority. A business plan and strategy was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.
Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

We saw several areas of outstanding practice including:

The practice had increased the flexibility of access to appointments and could demonstrate the impact of this by reduced use of accident and emergency facilities and the out-of-hours service, and positive patient survey results.
The practice had reached out to the local community by supporting people with learning disabilities who attended a local farm and a children’s adventure group should the need arise, for minor illness. The practice also supported the local church initiatives, for example in delivering food bank packages.
The practice funded and facilitated a walking for health group at the local village hall.
The practice funded physiotherapy, chiropody, a meditation group for mindfulness sessions and a counsellor for its registered population.
The practice provided weekly comfort visits as well as appointments and home visits to patients residing at three local care homes.
The practice worked with the local CCG in accepting patients who may be experiencing difficulties in registering with other practices for a variety of reasons, whose circumstances may make them vulnerable.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

Complete an Infection and Prevention Control audit.
Ensure that the practice maintains appropriate recruitment records and introduce systems to verify staff registration with their appropriate professional bodies.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Brown Clee Medical Centre

All Inspections

6 July 2023

During a monthly review of our data

16 August 2021

During an inspection looking at part of the service

30/07/2019