Archived: Moredon Medical Centre

We carried out an unannounced comprehensive inspection of Moredon Medical Centre on 13 and 14 August 2019, as part of our inspection programme. The inspection was a comprehensive follow up of the Special Measures imposed on the provider in March 2019 under the previous provider arrangements, and to follow up on the urgent conditions that were removed under the new provider arrangements. The inspection approach was unannounced, in response to urgent concerns raised by whistle blowers, and information provided to us from other sources. On 13 August 2019, the inspection focused on activities carried out at the hub, and how The Better Health Partnership LP operated as the registered provider. On the 14 August 2019, the inspection focused on how the regulated activities were provided from the location Moredon Medical Centre.

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.

In September 2018, Moredon Medical Centre began working collaboratively with five other practices in the Swindon area, with the support of Integral Medical Holdings (IMH), who provide back-office services such as payroll, human resources, finance and management support. This collaboration was formed to maintain the services provided by these practices, and to look to develop new ways of working in line with the Government’s plan for primary care, the ‘General Practice Five Year Forward View’. In March 2019 the practice was registered under a new provider, the Better Health Partnership. This was predominately a business and legal entity change, with the same people being responsible for the running of the practice as with the previous provider IMH. In May 2019, IMH withdrew from providing support services, but the structure has remained the same, with all correspondence and back office functions being managed at Moredon Medical Centre, which is known as the hub.

We have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

• The practice did not have clear systems and processes to keep patients safe.
• The practice did not have appropriate systems in place for the safe management of medicines.
• The practice did not learn and make improvements when things went wrong.

We rated the practice as requires improvement for providing effective services because:

• There was limited monitoring of the outcomes of care and treatment.
• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.

We rated the practice as requires improvement for providing caring services because:

• Despite improvements, patient satisfaction scores were low relative to local and national averages.

We rated the practice as inadequate for providing responsive services because:

• Although improvements had been made, patients were unable to access services in a timely manner and there was a lack of continuity of care.

We rated the practice as inadequate for providing well-led services because:

• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
• While the practice had a clear vision, that vision was not supported by a credible strategy.
• The practice culture and structure did not effectively support high quality sustainable care.
• There was limited support from the provider Better Health Partnership to the local team at Moredon Medical Centre.
• The overall governance arrangements needed strengthening in order to be effective and sustainable.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• We saw limited evidence of systems and processes for learning, continuous improvement and innovation.

Following the inspection, we issued Warning Notices to the provider registration of the Better Health Partnership, which relate to the location Moredon Medical Centre. This was in regard to the significant issues relating to patient safety, and leadership and governance.

This service was placed in special measures in April 2019. Insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall. We will proceed 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 six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration 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

In September 2018, Abbey Meads Medical Group, Morden Medical Centre, Taw Hill Medical Practice, Eldene Surgery, and Phoenix Surgery began working collaboratively as a primary care network with the support of Integral Medical Holdings (IMH), who provide back-office services such as payroll, Human Resources, finance and management support. This collaboration was formed to maintain the services provided by these practices, and to look to develop new ways of working in line with the Government’s plan for primary care, the ‘General Practice Five Year Forward View’. The group is now known as the Better Health Partnership and was registered with CQC in March 2019. GP partners of the old practice continue to be on the new Better Health Partnership LP registration.

We carried out an unannounced focused inspection at Morden Medical Centre on 11 and 16 April 2019, in response to urgent concerns raised confidentially by staff, and information from other intelligence sources. We previously inspected Morden Medical Centre on 7 March 2019, to follow up on a Warning Notice we issued after inspections on 9 and 12 November 2018. The Warning Notice incorporated four breaches of regulations. At the 7 March inspection we found t he practice had made significant changes to their systems and processes, and the failings we itemised in the Warning Notice had all been addressed.

The inspection and enforcement activity in the above paragraphs resulted in the service, under the old provider, being placed in special measures.

The full report on the March 2019 inspection and the inspections in November 2018 can be found by selecting the ‘all reports’ link for Morden Medical Centre on our website at .

This report covers the unannounced follow-up focused inspection we carried out at Morden Medical Centre on 11 and 16 April 2019, to assess the level of risk to patient safety, and to assess the actions taken by the practice to improve the quality of care. We did not rate the practice as part of this unannounced focused inspection.

We issued the practice a Section 31 Notice of Decision to impose conditions on the provider registration with immediate effect. We found several breaches relating to safe and well-led services. Specifically:

• Systems and processes to manage patient correspondence were not effective or efficient and may place patients at risk of harm. We identified approximately 10,000 hospital letters (and correspondence from other sources), some of which we noted were dated from 2018, had not all been reviewed within two days of receipt. We also found 48 unassigned tasks that required action.
• Systems and processes to identify, record and monitor risk were insufficient to ensure improvements were made to ensure a high-quality service and patient safety was maintained. We looked at a sample of patients with prescriptions for high risk medicines and found the majority did not have a record of a medicines review within appropriate timescales.
• Assurance and auditing systems or processes that continually evaluate and seek to improve governance, risk and auditing practice were not effective or comprehensive enough to ensure quality of service and patient safety. We found the significant event policy was not always followed, and significant events were not always identified, recorded, investigated or discussed to ensure lessons learned were shared across the practice.
• Some staff did not receive appropriate support, training, professional development, supervision and appraisal. We found that a practice pharmacist had not received appropriate supervision, training or appraisals.
• The overall governance arrangements were ineffective. Conversations with some GPs and non-clinical staff on the days of inspection reported excessive work-loads, and not being able to have the time to undertake tasks.
• The practice did not have clear systems, practices and processes to keep people safe and safeguarded from harm.

The areas where the provider must make improvements are:

• Ensure care and treatment are provided in a safe way for service users.
• Ensure staff receive appropriate support, training, professional development, supervision and appraisal to enable them to carry out the duties they are employed to perform.
• Establish effective systems and processes to ensure good governance, in accordance with the fundamental standards of care.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care