We carried out an announced comprehensive inspection at Abbey Meads Surgery on 24 February 2020 as part of our inspection programme. This location is registered under the Great Western Hospitals NHS Foundation Trust and the Abbey Meads Surgery inspection took place during the same period of their trust wide inspection.
At this inspection we followed up on the areas of concern highlighted under the previous provider who was placed into special measures in June 2019.
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.
We rated the practice as inadequate for providing safe services because:
- The practice did not always have clear systems and processes to keep patients safe.
- The practice did not always have appropriate systems in place for the safe management of medicines.Following the inspection the provider shared prescribing events and training that some of the prescribers had attended and a programme of supervision was implemented immediately.
- There was a backlog of approximately 1000 unsummarised records.
- Staff vaccination records were not up to date, however the practice had been updating the staff records before the inspection and this was still in progress.
- The staffing capacity was still at reduced levels which meant delays in the provision of services of improvement being made.
- The management of emergencies could be delayed due to emergency equipment being stored in different locations and not all the recommended emergency medicines were available. Following the inspection the practice made immediate changes to the storage and medicines available.
- There was limited management of safety alerts to ensure appropriate actions were taken.
We rated the practice as inadequate for providing effective services because:
- There was limited monitoring of the outcomes of care and treatment and outcome measures showed a significant decline from the previous year. There was no comprehensive plan to address the poor performance until we highlighted this as a more urgent risk during the inspection.
- There was limited quality improvement measures or programme of quality improvement.
- There were gaps in staff training, including the mental capacity act.
- Nursing staff had not had an appraisal in over 12 months. However, further records received following the inspection demonstrated other staff had received appraisals and those overdue had a planned date.
We rated the practice as requires improvement for providing responsive services because
- We found improvements to services had been made and access had improved since the new provider had started to manage the service in November 2019. However, on the day of inspection patients were still experiencing delays in accessing care and treatment.
We rated the practice as requires improvement for providing well-led services because
- Improvements were needed for governance systems, accurate and reliable data, the management of risks, and patient and staff engagement.
- The new provider had undertaken due diligence assessments to understand the significance of the issues identified from the previous provider. However, the issues identified were more significant when the new provider began working within the practice.
- The provider recognised the significant improvement and transformation that Abbey Meads Surgery required. However, at the time of the inspection some of the changes and improvements had not been implemented as the new provider had only commenced the management of the service 12 weeks before.
The population groups of older people and families, children and young people were rated as requires improvement. The long term conditions and people experiencing poor mental health (including people with dementia) were rated as inadequate. Working age people (including those recently retired and students) and people whose circumstances make them vulnerable were rated as good.
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.
- The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a more timely way.
The areas where the provider must make improvements are:
- Ensure that care and treatment is provided in a safe way.
- Ensure staff receive appropriate support, training, 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.
(Please see the specific details on action required at the end of this report).
The areas where the provider should make improvements are:
- Implement a process to ensure failed attendance of children’s appointments following an appointment in secondary care or for immunisation are followed up.
- Improve cervical cancer screening uptake rates.
- Continue to ensure regular multi-disciplinary case review meetings for all patients on the palliative care register
Following the inspection, we issued the provider with a Letter of Intent. The Letter of Intent offered the provider the opportunity to put forward documentary evidence which may provide assurance that the risks identified have already been removed or mitigated through an action plan. We received an action plan, setting out how the provider had already addressed each of the concerns we identified, or how they intended to address them. The action plan set out a specific time frame for implementing each outstanding action and who would be doing it, with documentary evidence supporting any actions taken or intended. Based on the action plan, we were assured that the risks identified would be addressed.
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