On 10 and 13 July 2018 we carried out a full comprehensive inspection of Dodworth medical practice. This resulted in the practice being placed in special measures and Warning Notices being issued against the provider on 1 August 2018. The Notices advised the provider that the practice was failing to meet the required standards relating to Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Safe care and treatment, Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Good governance and Regulation 19 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Fit and proper persons employed.

On 11 September 2018 we undertook a focused inspection to check that the practice had met the requirements of the Warning Notice for Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that although some improvement had been made and some systems had been introduced further improvements were still required to ensure that safety was maintained.

In particular we found that:

• The cold chain was now being appropriately managed and medicines were in date.
• The repeat prescribing policy had been reviewed and reflected the local Clinical Commissioning Group guidelines.
• The system to monitor paper and electronic correspondence through the practice had been reviewed and was being monitored.  Actions were now being managed within the time frames allocated by the provider.
• Security of blank prescriptions had been reviewed and these were now tracked through the practice.

• The practice had reviewed the system for recording significant events. However, we found that there were still further improvements to be made to this system as not all staff completed the forms and the relating policy or procedure were not routinely reviewed as part of the investigatory process.

• A new system was in place for safety alerts including Medicines and Healthcare products Regulatory Agency (MHRA). 

• A fire risk assessment of the premises had been completed and the provider had arranged for a legionella, infection prevention and control and health and safety risk assessments to be completed in September 2018.

• Administrative and reception staff had not undertaken infection prevention and control training, this was scheduled for 19 September 2018. Clinical and medical staff had undertaken the appropriate level of child safeguarding training.

• The provider was in the process of establishing staffs immunisation status in line with the guidance 'immunisation against infectious diseases ('The Green Book' updated 2014).

The rating awarded to the practice following our full comprehensive inspection on 10 and 13 July 2018 of ‘inadequate’ remains unchanged. The practice will be re-inspected in relation to the Warning Notices for regulation 17 and 19 and the overall inadequate rating in the future.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as inadequate overall. 

We carried out an announced focused inspection at Dodworth medical practice on 28 November 2017 following feedback to the Care Quality Commission. As we did not look at the overall quality of the service we were unable to provide a rating for the service. We found shortfalls in relation to the recruitment of staff which resulted in a breach of regulation. The focused report on the November 2017 inspection can be found by selecting the “all reports” link for Dodworth Medical Practice on our website at www.cqc.org.uk.

This inspection was an unannounced comprehensive inspection at Dodworth medical practice  on 10 and 13 July 2018 and was prompted following information of concerns raised with the Commission.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Not rated

Are services responsive? – Requires improvement

Are services well-led? - Inadequate

At this inspection we found:

• We found significant concerns in the leadership and governance of the practice. The provider did not have a systematic approach when taking over this practice to assess the risks in order to provide adequate leadership to support the governance systems.
• The practice did not have clear systems in place to manage risk so that safety incidents and significant events were less likely to recur. When incidents did happen, the practice did not effectively learn from them and improve their processes. 
• There was little understanding or management of risks and issues, and there were significant failures in performance management and audit systems and processes. There were very few risk or issue registers in place. Those that were in place were rarely reviewed or updated.
• The practice did not routinely review the effectiveness and appropriateness of the care it provided. It did not ensure that care and treatment was delivered according to evidence- based guidelines.  Staff groups tended to take the lead rather than be driven by the leadership of the practice.
• Not all staff members had received the training required to carry out their roles effectively. For example, safeguarding, infection and prevention control and fire safety.

• On the day of inspection we saw staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients told us the appointment system had recently improved, it was easy to use and care could be accessed when needed.  However, patients reported lack of continuity of care when seeing doctors.

​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.

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

• Ensure specified information is available regarding each person employed

The areas where the provider

should

make improvements are: 

• Review the approach for identifying and providing support to patients with caring responsibilities.

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

Letter from the Chief Inspector of General Practice

We carried out a focused announced inspection of Dodworth Medical Practice on 28 November 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned following feedback to the Care Quality Commission to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

This inspection covers the specific areas we reviewed as a result of the feedback received. As we did not look at the overall quality of the service we are unable to provide a rating for the service.

At this inspection we found:

• The practice provided staff with ongoing support. This included an induction process, training, informal one-to-one meetings, clinical supervision and support for revalidation. Staff were new in post and appraisals were planned for April 2018.

• Systems and processes were in place to manage communications and the review of test results and staff were aware of their roles and responsibilities including requests for home visits.

• Leaders were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.

• We saw policies were in place to govern records management activity and processes were in place to manage clinical tasks. However, systems to manage Disclosure and Barring Services (DBS) checks were not effective. One DBS check was not in place for a member of the clinical team and there were no risk assessment. This was not in line with the practices recruitment policy and procedure.

Importantly, the provider must:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice