This practice is rated as Inadequate overall. (Previous rating January 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires Improvement

Are services responsive? – Inadequate

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Dr Mahadeva Selverajan (also known as Deane Clinic One Stop Health Centre) on 6 November 2018. The inspection was part of our regulatory functions to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. Overall the practice is rated as inadequate.

At this inspection we found:

• There was insufficient GP cover to manage long term conditions of patients safely and effectively. For example no GP on-site two days per week, leaving the advanced nurse practitioner unsupervised during clinics.
• Patients were at risk of harm because systems and processes were not sufficiently implemented to keep them safe. We found concerns around incident reporting, clinical record keeping, patient safety alerts, prescription protocols, emergency equipment, fridge monitoring and information sharing.
• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of formal communication and learning between staff.
• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement. There was no evidence of quality monitoring other than the Quality Outcomes Framework (QOF) which is a voluntary annual reward and incentive programme for GP surgeries.
• All practices in Bolton are signed up to the Bolton Quality Contract which is a Clinical Commissioning Group (CCG) incentive to monitor whether practices are providing the best services for patients in their population. It has been in place for four years. The practice joined this initiative in August this year.
• Not all patients were positive about their interactions with staff and some commented through various avenues that they were not treated with compassion and dignity. Those comments were perceived by the practice as disingenuous and were not responded to.
• Complaints were not sufficiently dealt with.
• Recruitment checks and personnel information were not sufficiently maintained in accordance with requirements.
• Appointment systems were not working well enough so that all patients received timely care when they needed it.
• There was insufficient practice leadership and no evidence of a whole team approach.

The areas where the provider must make improvements are as follows :

• Ensure care and treatment is provided in a safe way to patients
• Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure specified information is available regarding each person employed and any such action as is necessary and proportionate is taken when any member of staff is no longer fit to carry out their duties

The areas where the provider should make improvement are:

• Improve access and processes for making appointments.
• Engage with the patient population

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

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

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Deane Clinic One Stop Health Centre. The practice was registered with the Care Quality Commission to provide primary care services.

We undertook a planned, comprehensive inspection on 3 December 2014 and spoke with patients, staff and the practice management team.

The practice is rated as good overall. We found an innovative, caring, effective, responsive and well-led practice that provided a service which met the needs of the diverse population it served. Our key findings were as follows:

• Safety was paramount in the practice and all staff were encouraged to maintain high standards. The practice staff were transparent and inclusive and used learning from incidents, complaints and patient feedback to improve the service they provided.
• There was an air of willingness by all staff to do the best for their patients which included looking at the patient holistically rather than just focusing on the problem they were attending the practice for.

We saw areas of outstanding practice. For example :

• The practice had reached out to the local community by approaching mosques, churches and schools and had attended them to promote better health. If any underlying health issues were identified the patients (if they belonged to the practice) were offered an appointment at the practice and patients from other practices were advised to attend their own GP. Patients were also signposted to other services within the community such as weight management classes or counselling services.

• We saw excellent examples of close working partnerships with other health and social care professionals which included care planning. Care Plans were in place for two per cent of the practice patients as part of a locally enhanced service and with a view to avoiding unplanned admissions to hospital. Care plans were very personalised and holistic and the practice nurse took great pride in their responsibility for ensuring the plans were maintained, reviewed and updated whenever changes occurred or at least three-to-six monthly.

• There were several other services available to patients of the practice. The lead GP was trained and had equipment on-site to undertake tests and carry out treatment in audiology and dermatology. The practice also employed an ophthalmologist and the GP was trained and had equipment to carry out ultrasound and diagnose bone, muscle and joint disease. These services enabled early diagnosis and reduced inappropriate referrals to secondary services.

• This practice showed outstanding examples of improving access for patients. A recent access audit had been undertaken by Bolton CCG and had identified that Deane Clinic scored highest (93.75%) for the total number of contacts per 1,000 patients when compared to their peer group and also within the CCG. They also scored highest (31.12%) for urgent appointments and the use of telephone consultations (27.17%). They have identified that their flexible access facility has reduced use of the out of hours (OOH) facilities. Patients spoken with told us they were happy with the access and were able to get an appointment when they needed one.

We saw areas where the practice should improve. For example :

• Chaperone training for front line staff was ineffective because it did not cover all the requirements such as where to stand during intimate examinations and how to record their attendance on the patient record.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice