Background to this inspection
Updated
5 October 2020
Mevagissey Surgery is located at River Street, Mevagissey St Austell PL26 6UE. There is a dispensary at the location, Mevagissey Surgery.
There is also a branch located at Gorran Haven, Old Lime Kiln, Gorran Haven, St Austell, PL26 6JG.
We have previously visited the location and branch site at our February 2020 inspection. Due to the current COVID-19 pandemic we did not visit either premises instead undertaking our assessment via remote access.
The practice is registered with the CQC to carry out the following regulated activities - diagnostic and screening procedures, treatment of disease, disorder or injury, surgical procedures, family planning, maternity and midwifery services and treatment of disease, disorder or injury.
Mevagissey Surgery is situated within the Kernow Clinical Commissioning Group (CCG) and provides services to approximately 5,270 pts patients under the terms of a general medical services (GMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.
The provider, Veor Surgery, who are formed of two partners (one of whom is a GP and the other is a managing partner) took over the practice in August 2019.
There was a salaried GP, a pharmacist who worked at the practice two days per week, two paramedics with extended skills, dispensers, a nurse, an assistant practitioner and a phlebotomist. The practice also employed a centre manager and five administrators. Resilience support was in place from Kernow Clinical Commissioning Group in the form of a project manager, practice manager, nurse and GP. There were two further GPs employed on a locum basis to provide additional clinical support.
Mevagissey Surgery was open form 8.30am until 1.15pm and the from 2pm until 5.30pm. Appointments were available at the branch on Monday and Thursday mornings. Outside of these times patients are directed to contact the out-of-hours service by using the NHS 111 number.
Information published by Public Health England, rates the level of deprivation within the practice population group as five, on a scale of one to ten. Level one represents a higher level of deprivation and level ten the lowest. Male life expectancy is 81 years compared to the national average of 79 years. Female life expectancy is 86 years compared to the national average of 83 years.
Updated
5 October 2020
We carried out an unannounced responsive comprehensive inspection at Mevagissey Surgery on 12 and 13 February 2020 following information received from stakeholders and a review of the information available to us.
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 inadequate overall. All population groups are rated as inadequate overall.
We rated the practice as inadequate for providing safe services because:
- Systems and processes do not keep patients safe.
- Clinicians did not have access to consultation history and previous clinical actions to ensure they were able to deliver safe care and treatment.
- 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. Safety is not a sufficient priority.
- Patients were at risk of harm or abuse as background checks had not been carried out on staff in clinical roles.
We rated the practice as inadequate 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 deliver good quality care.
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There was limited monitoring of patient’s outcomes of care and treatment. Patient’s outcomes were worse than expected when compared with similar services. Necessary action was not being taken to improve these outcomes.
The practice did not have adequate systems in place to monitor, review and provide care and treatment for patients.
- Some performance data was significantly below local and national averages, which showed that patients were not being supported to live healthier lives.
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 vision, that vision was not supported by a credible strategy.
- The practice culture did not effectively support high quality sustainable care.
- The overall governance arrangements were ineffective.
- 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.
- There was minimal evidence of systems and processes for learning, continuous improvement, innovation or reflective practice.
We rated the practice as good for providing caring services because:
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
We rated the practice as requires improvement for providing responsive services because:
- Staff lacked the relevant knowledge to book patients in with the appropriate clinician resulting in delays to appointments.
- Patients were not able to access care and treatment in a timely way.
- Complaints and concerns were not handled appropriately. Patient’s concerns did not lead to improvements in the quality of care.
The areas where the provider must make improvements are:
- Ensure that care and treatment is provided in a safe way.
- Ensure patients are protected from abuse and improper treatment.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, supervision and appraisal necessary to enable them to carry out the duties.
- Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
(Please see the specific details on action required at the end of this report).
The areas where the provider should make improvements are:
- Improve uptake of cervical screening.
- Improve identification of registered patients who are carers.
Following this inspection, we undertook enforcement action against the provider, Veor Surgery.
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 population group, 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 Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care