6 December 2022
During an inspection looking at part of the service
We carried out an announced comprehensive at Central Surgery on 6 December 2022. Overall, the practice is rated as inadequate.
Safe - inadequate
Effective - requires improvement
Caring - good
Responsive - requires improvement
Well-led - inadequate
Following our previous inspection on 14 March 2019, the practice was rated good overall and for all key questions.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Central Surgery on our website at www.cqc.org.uk
Why we carried out this inspection
We carried out this inspection to follow up concerns in line with our inspection priorities. This was a comprehensive inspection and looked at the key questions inspected, are services safe, effective, caring, responsive and well-led.
How we carried out the inspection/review
This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.
This included:
- Conducting staff interviews using telephone and video conferencing.
- Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
- 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 found that:
- Patients did not always receive effective care and treatment that met their needs. The practice did not always routinely review the effectiveness and appropriateness of the care it provided. There were some gaps in the process for monitoring patients’ health in relation to the use of medicines including high risk medicines, and patient records did not contain sufficient documentation to reflect their review or consultation.
- Governance processes were not followed appropriately to manage risk. Actions had not been taken in response to health and safety and fire safety risk assessments. Staff training and pre-employment recruitment checks were not sufficient. Learning from significant events and complaints was not widely shared with all clinical staff. There was minimal quality improvement activity carried out.
- There were concerns with access to the branch site. The opening hours were not clearly publicised, and the site was not always adequately staffed for the clinics being run. Facilities at the branch site were limited for patients using a wheelchair.
- Staff feedback was generally negative. They did not always feel able to raise concerns or feel supported.
- We found good systems in place to manage safeguarding processes, significant events and complaints.
- The practice was the lead within the Primary Care Network for patients from Ukraine. They received patients from a local hotel that housed refugees and asylum seekers. A register was kept of these patients and they were all offered routine vaccinations within 14 days of registration.
We found breaches of regulations. 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.
The areas where the provider should make improvements are:
- Continue to encourage the uptake of cervical screening.
- Consider ways to support patients that have been identified as carers.
- Continue to take measures to improve patient satisfaction with the service.
- Display CQC ratings conspicuously and legibly at each location delivering a regulated service and on the practice website.
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 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.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA
Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services