We carried out an announced comprehensive inspection of Bilborough Medical Centre in April 2018; the practice was rated as inadequate overall and we took urgent action in line with our enforcement procedures to impose the following conditions on the provider’s registration:

• Condition 1 -The registered provider must, with immediate effect, significantly strengthen the clinical leadership and oversight arrangements at Bilborough Medical Centre to support compliance with the requirements of the fundamental standards as set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider must provide the Care Quality Commission with evidence to support the changes made by 5pm on Monday 23 April 2018.
• Condition 2 -The registered provider must review and assess the competencies of all nursing staff working within Bilborough Medical Centre to check that they have the required knowledge, skills and competencies to undertake their roles. The registered provider must provide the Care Quality Commission with evidence to support this by 5pm on Wednesday 25 April 2018.
• Condition 3 - The registered provider must, with immediate effect, review consultations, prescribing and patient records to ensure that patients have not come to harm with regards to concerns found in relation to the consultations and prescribing by the nurse practitioners. The registered provider must provide the Care Quality Commission with evidence to support this by 5pm on Wednesday 25 April 2018.
• Condition 4 -The registered persons must ensure that medicines reviews are carried out for each patient prescribed high risk drugs by no later than 5pm on Wednesday, 25 April 2018.
• Condition 5 -The registered persons must provide the Care Quality Commission with written documentation that sets out their arrangements for ongoing monitoring of patients being prescribed high risk drugs by no later than 5pm on Friday, 27 April 2018
• Condition 6 -The registered persons must carry out a review of all abnormal test results received up to and including Friday 20 April 2018 and ensure that the patients concerned are contacted no later than 5pm on Wednesday, 25 April 2018.
• Condition 7 - The registered persons must provide the Care Quality Commission with written documentation that sets out their arrangements for the ongoing monitoring of abnormal test results and ensuring that patients are contacted without delay by no later than 5pm on Friday, 27 April 2018
• Condition 8 - Unless given prior written permission by the Care Quality Commission, the registered persons must not register any new patients at Bilborough Medical Centre unless those patients are the newly born babies, newly fostered or adopted children of patients already registered at Bilborough Medical Centre.

We carried out an unannounced focused inspection at Bilborough Medical Centre on 24 May 2018. This inspection was undertaken in response to continuing concerns about the service being provided. Bilborough Medical Centre was not rated as part of this inspection. The overall rating for Bilborough Medical Centre remains inadequate.

At this inspection we found:

•Care and treatment was not always delivered according to evidence-based guidelines. Records of clinical consultations were not always sufficiently detailed.

•Prescribing was not always undertaken in line with guidelines.

•Significant events and incidents were not always fully investigated and addressed.

•Arrangements to ensure that staff were providing safe, quality care were not operated effectively.

•There were not enough appointments to meet the needs of patients.

•Staff did not always feel supported to raise concerns and were not always assured these would be addressed.

This service will remain in special measures. Services placed in special measures will be inspected again within six months of being placed into special measures. 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 further 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

This practice is rated as inadequate overall.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Inadequate

Are services responsive? – Inadequate

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at Bilborough Medical Centre on 18 April 2018. This inspection was carried out as part of our inspection programme and following a registration change in 2017.

At this inspection we found:

• The practice did not have clear systems in place to manage risk so that safety incidents were less likely to happen. When incidents did happen, these were not always reported.
• There were limited arrangements in place to review the effectiveness and appropriateness of the care being provided. Care and treatment was not always delivered according to evidence- based guidelines.
• Arrangements for monitoring and reviewing prescribing did not ensure that patients were kept safe.
• Arrangements were not in place to ensure that staff were working within the scope of their competency.
• During our inspection we saw that staff treated patients with compassion, kindness and respect. However, the privacy and dignity of patients was not always respected.
• There were not enough appointments to meet the needs of patients; appointments were not always long enough to ensure adequate time to treat patients properly.
• Patients found it difficult to get through the practice by telephone.
• Governance arrangements were not being operated effectively to ensure the delivery of high quality, sustainable care.

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

The areas where the provider should make improvements are:

• Review and improve arrangements for the identification of carers in order to offer them with support where needed

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.

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