Carpenters Practice

We carried out a focused unannounced inspection of the Carpenters Practice on 30 April and 5 May 2021, as a result of concerns raised with the CQC.

We previously carried out announced inspections at Carpenters Practice in 2015, 2018 and 2019 where the practice was consistently rated good in all key questions and overall, and there were with no regulatory breaches.

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.

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.

At this inspection, we have rated the practice as Inadequate overall.

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

• In response to the coronavirus (COVID-19) pandemic, we found the provider was not following Public Health England COVID-19 guidance.
• Arrangements for the prevention and control of infections were ineffective and standards of cleanliness and hygiene were not met.
• There was no effective COVID-19 patient or staff screening or action prior to or following a symptomatic staff member testing COVID-19 positive.
• We identified examples of unsafe clinical care, including in relation to administering vaccines, contraceptive pill checks and peak flows with no related risk assessments.
• The practice had not ensured effective medicines management which exposed service users to the risk of harm, including in relation to emergency medicines and refrigerated medicines.
• The practice had not ensured premises and equipment safety, including premises and equipment cleaning and not securing areas that posed risks to patients.

We rated the practice as Inadequate for providing effective services because:

• The practice was unable to demonstrate that clinical and non-clinical staff had the skills, knowledge and experience to carry out their roles.
• There were no effective arrangements for the oversight of clinical care.

These areas affected all population groups, so we rated all population groups as Inadequate for providing effective services.

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

• Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.
• The practice culture did not effectively support high quality sustainable care. There was high staff turnover across clinical and non-clinical roles and no evidence of inductions for new staff members.
• There were no clear responsibilities, roles and systems of accountability to support good governance and management.
• The overall governance arrangements were ineffective. For example, the whistleblowing procedure. HR information was incomplete and unclear such as staff files and the staff rota.
• The practice did not have clear and effective processes for managing risks, issues and performance. Significant and extensive concerns that were raised by staff nine months prior to our inspection had not been resolved.
• Staff were unclear and unable to access fundamental information and protocols such as how to determine what types of appointment may be urgent, signs of sepsis, and significant events guidance.
• There was no effective process for identification, management and oversight of risk such as provider self-audits to evaluate quality and safety including patient access and complaints.

The areas where the provider must make improvements are:

• 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.

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

Due to the seriousness of the concerns we issued the provider with a notice of possible urgent enforcement action on Friday 7 May 2021, under Section 31 of the Health and Social Care Act 2008. This notice offered the provider an opportunity to submit action plan evidence by Monday 10 May 2021 to reassure us that the risks we identified have been removed or are immediately being removed. The provider sent us a satisfactory time framed action plan and will be inspected again in accordance with risk and our regulatory functions to assess whether sufficient improvements have been made.

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.

The Carpenters Practice was taken over from the previous provider by AT Medics under a new contract on 1 July 2020 and AT Medics merged with another company in February 2021.

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