All inspections: Rigg Milner Medical Centre

We carried out an announced inspection at Rigg Milner Medical Centre on 23 February 2022. Overall, the practice is rated as requires improvement.

The ratings for each key question are as follows;

Safe - Requires Improvement

Effective - Requires Improvement

Caring - Requires Improvement

Responsive - Requires Improvement

Well-led - Requires Improvement

Following our previous inspection on 28 May 2021, the practice was rated Inadequate overall and for all key questions and placed in special measures.

As a result of our findings, we took enforcement action against the provider and imposed conditions. These included providing monthly updates as to progress against the issues we identified on inspection.

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

Why we carried out this inspection

This inspection was a comprehensive inspection to follow up on:

The conditions imposed on the providers registration at this location
Overall governance structures
Organisational culture
Whether the practice had displayed their rating on their website
Performance with cancer screening and childhood immunisations

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

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 Requires Improvement overall

We found that:

The structures to keep staff and patients safe, including safeguarding, had improved since our last inspection, however further work was still required.
Patients received effective care and treatment that met their needs.
Performance for preventative care had improved, however improvements were ongoing.
Action plans were now in place for some instances where issues had been identified either through patient feedback or risk assessment. Further work was required to embed this process and make it effective for all areas of improvements identified.
The management of medicines, including high-risk medicines had improved but further strengthening was required.
Documentation relating to Do Not Attempt Cardio Pulmonary Resusitation decisions required improvement.
The practice had implemented action plans to improve the experience of patients. They recognised this was a continuing journey.
Staff had received training to deal with patients with kindness, respect and to enable them listen and receive feedback in a constructive way.
The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients still experienced some issues with access however there had been some improvement.
The culture of the practice had significantly improved following our previous inspection.
Leadership of the practice was more appropriately balanced so staff skills were used more effectively.
Governance structures had been reviewed and strengthened. Although they were not fully embedded and further improvements were required, a large amount of progress had been made to improve the quality of care and the service provided.

We found one breach of regulation. The provider must:

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

Whilst we found no breaches of regulations, the provider should:

Improve the process to manage patients on the safeguarding register.
Continue to improve processes around medicines that require monitoring and the recording of Do Not Attempt Cardio Pulmonary Resusitation decisions.
Continue to improve performance relating to childhood immunisation, cervical cancer screening, access and patient satisfaction.
Improve online accessibility to information on complaints.
Continue to embed and review the effectiveness of processes and systems including staff training.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service.

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

We carried out an announced inspection at Rigg Milner Medical Centre on 28 May 2021. Overall, the practice is rated as Inadequate.

Safe - Inadequate

Effective - Inadequate

Caring - Inadequate

Responsive - Inadequate

Well-led - Inadequate

Following our previous inspection on 24 February 2020, the practice was rated Requires Improvement overall and for all key questions and population groups.

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

Why we carried out this inspection

This inspection was a comprehensive inspection to follow up on:

A requirement notice served following our last inspection relating to:

Legionella flushing.
Reviews of monitoring tests prior to prescribing a repeat medication.
The risk posed to two patients diagnosed with Atrial Fibrillation, who were not prescribed appropriate medicine to reduce the risk of a stroke.
Systems for patient feedback on satisfaction.
Sustainability of new governance systems.

Also, to review areas identified at our last inspection as a should:

Ensure that where actions are identified from a risk assessment, there is a clear, documented track of actions taken.
Continue to monitor and improve the practice performance for cancer screening and childhood immunisations.
Improve the effectiveness of the quality improvement and audit.
Review confidentiality arrangements for receptionists handling calls at the front reception desk.

How we carried out the inspection

Throughout the pandemic, the Care Quality Commission 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.
Sending a questionnaire to practice staff to complete.

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 Inadequate overall and Inadequate for all population groups.

We found that:

Not all areas identified at our last inspection had been addressed.
Systems in place to keep patients safe and safeguarded from abuse were not effective.
There were gaps in systems to assess, monitor and manage risks to patients.
Systems for learning and improving the quality of care were ineffective.
We were not assured that all staff were trained to perform their role, supported by leaders and aware of their roles and responsibilities, due to a lack of oversight and effective leadership.
There was limited evidence that where areas of lower performance were identified a whole practice approach was taken to drive improvements.
Feedback from patients about their experience of care and ability to access care and treatment remained below the local and national averages.
The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic.
Complaints were not being handling in accordance with guidance and the system was ineffective.
The culture within the practice was not conducive to staff feeling supported to put forward ideas to improve the quality of care or raise concerns.
The way the practice was led and managed did not promote the delivery of high-quality, person-centred care.

We found one repeated breach of regulation. The provider must:

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:

Take action to display the CQC rating and link to the latest report, on a website maintained by the practice.
Take proactive steps to improve the practice performance for cancer screening and childhood immunisations.

Due to the level of concerns identified at this inspection, as to non-compliance, the Commission decided to issue a notice of proposal to impose conditions on the provider’s CQC registration. For further information see the enforcement section of this report.

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. 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

We completed several inspections at this location under the previous provider of this service. The new provider was the lead GP in the previous partnership. As the previous history is relevant to the current provider, we have made reference to it during this report.

We have carried out inspections at the previous provider Dr Jones Sr Practice / Rigg Milner Medical Centre on 30 October 2018, 19 March 2019, 4 June 2019 and 20 August 2019. The practice had remained in special measures since our inspection of 30 October 2018. We were due to inspect the practice again, as part of our review of the practice, however, there was a change in provider which delayed this process.

We then carried out an announced comprehensive inspection at Rigg Milner Medical Centre on 24 February 2020 to rerate the practice and to ensure that improvements had been made.

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 requires improvement overall.

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

Non-clinical staff did not have the level of safeguarding training recommended by latest guidance.
It was not clear whether actions required from a fire risk assessment had been taken.
There was an ongoing lack of evidence that all appropriate actions to reduce the risk of legionella were being completed.
The system for monitoring patients prescribed warfarin did not provide assurance that the results of blood monitoring tests were checked prior to prescribing a repeat prescription.

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

We identified a small number of patients who were not receiving appropriate treatment for a long-term condition.
Performance for childhood immunisations and cervical screening was lower than national targets.
There was no process for checking whether consent had been sought appropriately.

Some of these areas affected all population groups so we rated all population groups as requires improvement.

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

Feedback from patients, from a variety of sources, around their experience at the practice was mixed.
For all five GP patient survey questions relating to this key question, there was deterioration in satisfaction levels from 2018 to 2019.

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

People were not always able to access care and treatment in a timely way.
Patient feedback, from a variety of sources, regarding access to appointments was mixed.

These areas affected all population groups so we rated all population groups as requires improvement.

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

There were not always clear responsibilities, roles and systems of accountability to support good governance and management.
There were processes for managing risks, issues and performance. However, they were still not fully effective.
The practice involved the public, staff and external partners to sustain high quality and sustainable care. However, they did not have effective systems for acting on patient feedback.

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

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

The areas where the provider should make improvements are:

Ensure that where actions are identified from a risk assessment, there is a clear, documented track of actions taken.
Continue to monitor and improve the practice performance for cancer screening and childhood immunisations.
Improve the effectiveness of the quality improvement and audit.
Review confidentiality arrangements for receptionists handling calls at the front reception desk.

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

Rigg Milner Medical Centre

All Inspections

23 February 2022

During a routine inspection

28 May 2021

During a routine inspection

24 February 2020

During a routine inspection