During our previous inspection of Clayhill Medical Practice on 13 January 2015, we rated the practice as good.

We carried out an announced comprehensive inspection at Clayhill Medical Practice on 12 February 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 have clear systems and processes to keep patients safe.
• We did not see evidence of recruitment systems and ongoing checks.
• Systems for infection control and prevention were not effective.
• The practice did not learn and make improvements when things went wrong.
• There were gaps in systems to assess, monitor and manage risks to patient safety.
• Staff did not always have the information they needed to deliver safe care and treatment.
• Some of the systems for medicines management required strengthening.

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

• There was no consistency in the care and treatment of patients between the two GP partners.
• The practice was unable to show that all staff had the skills, knowledge, experience and support to carry out their roles.
• Some performance data including screening data was lower than local and national averages. Some childhood immunisations data was lower than target levels.
• Unverified performance data supplied by the practice showed that performance had deteriorated over the last 11 months, with no capacity to significantly improve this before the end of the March 2019.
• Although there was effective coordination with other organisations to ensure patients had access to the appropriate support; there was insufficient evidence to show this was consistent for both GP partners.

These areas affected all population groups so we rated all population groups as inadequate.

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

• GP survey data was lower for three indicators relating to patients’ experience during consultations.
• Due to a lack of communication between the two GP partners which affected the consistency of approaches to care coordination, there was not sufficient assurance that the service always met patients’ needs. GP survey data supported this finding.
• The system for handling complaints was not consistent across the practice, there was limited learning or evidence that learning was shared.
• Patients were positive about their experience of making an appointment.
• Patients felt treated with kindness and respect by staff.

These areas affected all population groups so we rated all population groups as requires improvement for providing responsive services.

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

• The lack of communication and coordination between the partners affected all governance arrangements and meant that there was no assurance that all patients received the same standard of care and treatment.
• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• We saw little evidence of consistent systems and processes for learning, continuous improvement and innovation.

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:

• Improve the experience of patients whilst in their consultation.
• Consider how the practice can increase uptake of childhood immunisations and public health screening programmes.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Clayhill Medical Practice on 13 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for the older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances, and people experiencing poor mental health (including people with dementia).

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed, addressed and shared with staff during meetings.

• Risks to patients were assessed and infection control audits undertaken on a regular quarterly basis.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain was readily available and easy to understand.

• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The practice held a successful health awareness open day on a Saturday in October 2014, which was well received by partner agencies and people in the local community who had attended. This event offered advice and information, and raised the profile of the practice in the local community

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice