Archived: Orton Bushfield Medical Centre

We carried out a comprehensive inspection of Orton Bushfield Medical Centre on 9 June 2015. The practice was rated as requires improvement for providing safe and effective services and good for providing responsive, caring and well-led services. As a result of the findings on the day of the inspection the practice was issued with requirement notices for Regulation 9 (Person-centred care) and Regulation 19 (Fit and proper persons employed). A further inspection was completed on 8 March 2016 to follow up on the breaches of regulation. Following this inspection, the practice was rated as good overall and for all key questions.

We carried out a comprehensive inspection of Orton Bushfield Medical Centre on 27 July 2018. The practice was rated as inadequate overall with ratings of inadequate for providing responsive and well led services, requires improvement for safe, effective and for caring services. As a result of the findings on the day of the inspection the practice was issued with a warning notice for Regulation 17 (Good governance).

A further inspection was completed on 18 December 2018 to follow up on the breaches of regulation. Following this inspection, we found the practice had made sufficient improvements to satisfy the warning notice for Regulation 17 (Good governance). A requirement notice remained in place for Regulations 17 & 19 (Fit and proper persons employed).

You can read our findings from our last inspections by selecting the ‘all reports’ link for Orton Bushfield Medical Centre on our website at .

This inspection was an announced comprehensive inspection. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

At this inspection we found:

• The practice had made and sustained improvements to the monitoring of patients prescribed high risk medicines since our previous inspection visit in September 2018.
• The practice had implemented a new appraisal system to ensure they are able to monitor staff performance and to enable staff to provide feedback; however, the practice was unable to provide evidence on how clinical staff were competency assessed.
• The practice had implemented a new training matrix to ensure oversight of staff training, where training was found to be overdue, the practice had booked members of staff on relevant courses.
• The practice had obtained copies of building risk assessments relating to fire safety, health and safety and legionella; however, the practice had not gained oversight on the actions required. The legionella risk assessment was due for review in January 2019 and at the time of inspection this had not been completed.
• We found the practice had implemented monthly clinical and non-clinical meetings, which were all recorded and distributed amongst all staff. However, the improvements had not been sustained and meeting records we reviewed were not always accurate or detailed.
• The practice’s new process for handling, recording and learning from significant events and complaints was not always effective.
• We found a single glucose tablet with an expiry date of October 2018.
• The practice’s Quality Outcomes Framework performance had not improved since our last inspection and some indicators had declined since the previous inspection and exception reporting had increased.
• The practice had started to implement a process of responding to patient feedback. The practice had started to respond to all patients on NHS Choices and had implemented a new telephone system in response to the GP National Patient Survey. However, the effect of the new telephone system was unclear as it had not been evaluated.
• The practice’s uptake of some childhood immunisations was below World Health Organisation targets.
• The practice was unable to provide us with an accurate list of carers they supported due to a coding issue, the practice were aware of this and planned to review their records.
• Patient feedback in relation to the caring attitude of staff had improved since the previous inspection.
• Staff feedback was positive in relation to working at the practice and being supported by the leadership team.

At the previous inspection, the practice was rated as requires improvement for providing safe services. At this inspection, the practice remained rated as requires improvement for providing safe services because:

• We found that staff recruitment and ongoing checks were not always completed. This was previously raised at our September 2018 inspection.
• We found a lack of oversight of risk assessments to ensure patients and staff would be kept safe; for example, legionella risk assessment, portable appliance testing and actions arising from fire risk assessment. This was previously raised at our September 2018 inspection.
• We found a single glucose tablet with an expiry date of October 2018.
• The process for managing significant events was not always effective; this was previously raised at our July 2018 and December 2019 inspections.

At the previous inspection, the practice was rated as requires improvement for providing effective services. At this inspection, the practice was rated as requires improvement for providing effective services because:

• The practice’s uptake of childhood immunisations was below the World Health Organisation target percentage of 90% or more and this was on a downward trajectory from previous years.
• The practice’s performance for mental health indicators was below the CCG and England averages and the practice had no actions in place to try to drive improvement in this performance.
• The practice had not fully embedded or sustained actions since our previous inspection in July 2018. For example, the oversight of clinical staff competencies was unclear.

At the previous inspection, the practice was rated as requires improvement for providing caring services. At this inspection, the practice was rated as good for providing caring services.

At the previous inspection, the practice was rated as inadequate for providing responsive services. At this inspection, the practice remained rated as inadequate for providing responsive services because:

• Patient feedback through the GP National Patient Survey, NHS Choices, Google reviews and feedback on the day of the inspection was negative in relation to accessing the practice. The practice had installed a new telephone system to create further telephone lines but continued to only use one member of staff to answer the lines. The new telephone system had also not been evaluated by the practice to monitor any improvement.
• Patients we spoke with on the day of the inspection told us how difficult it was to access the practice by telephone and gave us examples of the difficulties they faced when trying to make appointments.
• The process for recording and handling and learning from complaints and feedback was still not effective.

At the previous inspection, the practice was rated as inadequate for providing well-led services. At this inspection, the practice remained rated as inadequate for providing well-led services because:

• We found the practice had not made improvements to address all of the concerns noted in our previous inspection reports. Where the practice had made improvements, not all of these had been sustained.
• During this inspection we identified new concerns.
• We found a lack of leadership capacity and capability to successfully manage challenges and implement and sustain improvements.
• We found the practice were in breach of registration regulations due to the previous partnership dissolving and the practice not correctly re-registering as a single-handed provider. We acknowledge that an application had been made; however, this required further information to enable the registration to be progressed.
• We found the governance systems and the oversight of the management did not ensure that services were safe and that the quality of those services was effectively managed.

The areas where the provider must make improvements are:

• 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:

• Review and improve the process for identifying carers at the practice.
• Review and improve the process for embedding competency checks for new clinical staff.
• Review and improve Quality Outcomes Framework exception reporting for diabetes indicators and outcomes for people experiencing poor mental health.
• Review and improve the practice’s uptake of cancer screening programmes.
• Review and improve system for patients to access the practice by telephone.

I am keeping 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.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

We carried out a comprehensive inspection of Orton Bushfield Medical Centre on 9 June 2015. The practice was rated as requires improvement for providing safe and effective services and good for providing responsive, caring and well-led services. As a result of the findings on the day of the inspection the practice was issued with requirement notices for Regulation 9 (Person-centered care) and Regulation 19 (Fit and proper persons employed). A further inspection was completed on 8 March 2016 to follow up on the breaches of regulation. Following this inspection, the practice was rated as good overall and for all key questions.

We carried out a comprehensive inspection of Orton Bushfield Medical Centre on 27 July 2018. The practice was rated as inadequate overall with ratings of inadequate for providing responsive and well led services, requires improvement for safe, effective and for caring services. As a result of the findings on the day of the inspection the practice was issued with a warning notice for Regulation 17 (Good governance). You can read our findings from our last inspections by selecting the ‘all reports’ link for Orton Bushfield Medical Centre on our website at .

This inspection was an announced focused inspection. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements as detailed in the warning notices issued on 23 August 2018.

Our inspection report from our inspection on 27 July 2018 is available on our website.

At this inspection we found:

• The system in place in relation to high risk medicines had been improved. We reviewed records of patients taking high risk medicines and found they had all been monitored appropriately.
• The practice had implemented a new appraisal system to ensure they are able to monitor staff performance and to enable staff to provide feedback.
• The practice had implemented a new training matrix to ensure oversight of staff training, where training was found to be overdue, the practice had booked members of staff on relevant courses.
• The practice had obtained copies of building risk assessments relating to fire safety, health and safety and Legionella. The property is managed by NHS Property Services and the practice had arranged a meeting with the landlord to discuss the actions required from the risk assessments.
• We found the practice had implemented monthly clinical and non-clinical meetings, which were all minuted and distributed amongst all staff. The meetings allowed the distribution of learning from significant events and complaints and to allow staff to provide feedback.
• The practice had started to implement a process of responding to staff feedback. The practice had started to respond to feedback on both NHS Choices and Google Reviews, in addition to implementing a number of actions in an attempt to improve patient satisfaction following the National GP Patient Survey.
• The practice had started to implement a new process for recording and handling significant events and complaints. We found the number of significant events and complaints recorded and investigated had improved, although further improvement was required as we were made aware of other significant events and complaints discussed in meetings but not formally recorded.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice