This practice is rated as Requires Improvement overall. The practice was previously inspected on 9 November 2017 and rated as inadequate overall.

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Requires Improvement

We carried out an announced at Dr Alan M Campion on 26 June 2018. The purpose of the inspection was to follow up concerns which were identified during our last inspection which we carried out on 9 November 2017. At that inspection we found that the registered person had not done all that was reasonably practicable to assess, monitor, manage and mitigate risks to the health and safety of patients who use services. There was a lack of effective policies procedures and governance to enable effective management of risks associated with fire, legionella, infection control, patient safety alerts, the management of medicines, emergency procedures, urgent referrals and recruitment. There was a lack of effective systems in place to monitor staff training and appraisal and there was no action plan in place to address areas of clinical performance which was below local national averages. There had been no documented internal meetings from the previous 12 months and the systems for managing complaints and significant events were lacking. Governance arrangements around chaperoning and safeguarding were also not effective.

The practice was placed into special measures and issued with two warning notices for breaches of regulations 12 (Safe care and treatment) & 17 (Good governance). The provider was asked to submit an action plan and provide periodic updates about their progress.

At this inspection we found:

• The practice had systems to manage most risks so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. However, the system for reporting incidents was not embedded and some staff did not know the established process for documenting significant events.
• Recruitment and training systems and processes had been revised. Most staff had the required recruitment checks undertaken and had completed essential training.
• The practice had produced a comprehensive action plan related to clinical performance targets. While the most up to date published data indicated the practice was performing below local and national averages in some areas; unverified data from 2017/18 showed that the practice had improved performance in these areas.
• Most systems and processes for the management of medicines were effective and safe, the most recently available published data indicated that prescribing of some antibiotics was above the local and national average. We saw that prescribing of these antibiotics deviated from national guidelines without evidence based justification, though in the first quarter of 2018 the level of prescribing was in line with the national average.
• There was evidence of quality improvement activity aimed at improving performance.
• Patient feedback data was mixed. While the information collected from patients via comment cards and interviews undertaken during the inspection was positive, national patient survey scores, based on data collected in early 2017, were below local and national averages for questions related to GP consultations. The results for 2017/18 showed improvement in this area.
• Feedback from patients on the day of the inspection indicated that they could access care when they needed it and that the online appointment system was easy to use. However national patient survey data indicated dissatisfaction with the process for making appointments and access. The practice had acted to address this concern prior to our last inspection but had not undertaken an assessment of patient views to see if satisfaction had improved in response to these changes. Data from the 2017/18 national patient survey, published after our inspection but based on data collected before our inspection, showed that the practice scored below local and national averages in relation to access.
• We saw evidence of staff training and learning and that action had been taken to improve performance against national targets.

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.

The areas where the provider should make improvements are:

• Consider ways to advertise support for bereaved patients.

• Review recruitment systems to ensure appropriate checks are completed.

• Review the amount of clinical time available to meet the needs of the practice population.

• Improve systems and processes to support the identification and record keeping of patients with caring responsibilities to enable appropriate support and signposting to be provided.
• Continue to develop and act on the quality improvement programme.
• Continue with planned work to provide a suitable environment to deliver the service which ensures that all patients can access the service.
• Explore ways to improve the uptake of cervical and breast cancer screening.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

This practice is rated as Inadequate overall. The practice was previously inspected on 28 April 2015 when the practice was rated as good overall.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – requires improvement

Are services caring? – requires improvement

Are services responsive? – requires improvement

Are services well-led? - Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The concerns raised in Safe Caring and Well Led affect all of the population groups. The population groups are rated as:

Older People – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those recently retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

We carried out an announced comprehensive at Dr Alan M Campion on 9 November 2017 as part of our inspection programme.

At this inspection we found:

• The practice had not taken action to assess or mitigate risks associated with fire, infection control legionella or health and safety.

• Safeguarding policies were not practice specific, non-clinical staff had not received safeguarding training and not all staff were chaperoning in accordance with current legislation and guidance.

• There was limited evidence of learning from significant events and no policy in place. The complaints process also did not function effectively.

• There was no evidence that the practice was taking action in response to patient safety alerts in accordance with their policy and there was no effective system in place for monitoring urgent diagnostic referrals.

• Medicines were not managed effectively. The practice could not locate Patient Group Directions (PGDs) for nursing staff and we found two expired medicines in the practice fridges.

• Not all staff had undertaken the required training and systems for recruitment and appraisals were ineffective or non-existent.

• The care plans we reviewed indicated that the practice was delivering treatment in accordance with current guidelines and best practice and we saw some evidence of worked which aimed to improve the quality of care provision. However, the practice achieved lower than the local and national averages in respect of a number of clinical and public health indicators. There was limited evidence of action taken to review below average performance and make improvements.

• Feedback from patients on the day of the inspection indicated that staff treated patients with compassion, kindness, dignity and respect. However, national patient survey scores showed the practice performed below local and national averages in respect of its GP consultations and satisfaction with reception staff.

• Most patients spoken to on the day of the inspection found the appointment system easy to use and reported that they were able to access care when they needed it. However, some patients told us that they had to wait a long time to be seen when they arrived for their appointment. The national patient survey showed the practice scored lower than others on questions related to access.

• Practice policies were not effective. Some policies were from other services and/or did not contain required information on leadership and governance arrangements. There was no evidence of internal meetings having taken place since January 2016.

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.

• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

• Ensure care and treatment is provided in a safe way to patients.

• Ensure patients are protected from abuse and improper treatment.

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

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

The areas where the provider should make improvements are:

• Consider ways to highlight bereavement and translation services.

• Continue with planned work to upgrade the practice premises.

I am placing this service in special measures. Services placed in special measures will be reinspected after a period of six months.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Alan Campion on 28 April 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing, safe, effective, caring, and responsive and well led services.

It was also good for providing services for older people, people with long term conditions; mothers, babies, children and young people; the working age population and those recently retired.; people in vulnerable circumstances and people experiencing poor mental health

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 and addressed.

• Risks to patients were assessed and well managed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Some 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 available and easy to understand.

• 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.

However there were areas of practice where the provider needs to make improvements.

Action the provider Should take to improve:

• Ensure all staff who undertake chaperone activities are suitably trained.
• Ensure availability of an automated external defibrillator (AED) or undertake a risk assessment if a decision is made to not have an AED on-site.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice