Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Groby Road Medical Centre on 27 January 2017. Overall the practice is rated as good.

This inspection was carried out to follow-up our previous comprehensive inspection which took place on 24 May 2016 when we rated the practice as inadequate overall. In particular, the practice was rated as inadequate for providing safe, effective and well-led services, requires improvement for being caring and good for being responsive. The practice was placed in special measures for a period of six months.

Following the inspection in May 2016, the practice submitted an action plan to the Care Quality Commission outlining how they would make the necessary improvements to comply with the regulations. The practice also invested in a practice resilience support programme provided by the Royal College of General Practitioners (RCGP) to provide diagnostic assessment and tailored intervention throughout the period of special measures. In January 2017, we found the practice had responded to the concerns raised at the previous inspection and significant improvements had been made.

The practice is rated as good for the provision of safe, caring and effective services and for being well-led and requires improvement for being responsive. Our improved rating of good reflects the positive development of leadership and management systems to deliver significant progress in improving services.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Significant improvements to risk management had been made and risks to patients were now being assessed and managed. The practice had implemented a risk register and employed the services of external specialists to carry out specific risk assessments such as for fire and legionella.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice had implemented a system of appraisals, mentorship and supervision, all members of staff had received an appraisal.
• The practice had implemented a meeting structure and a 12 month programme of meetings. Evidence showed that staff were working with multi-disciplinary teams to understand and meet the range and complexity of patients’ needs.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had implemented a new management structure. There was a clear leadership structure in place and staff told us they felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The practice had a clear vision that had improvement of service quality and safety as its top priority. The practice fully embraced the need to change, high standards were promoted and there was good evidence of team working.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Address the issues highlighted in the national GP survey in order to improve patient satisfaction, including access to appointments and ease of getting through to the practice by telephone.
• Review systems in place to manage and monitor processes to improve outcomes for patients in order to improve exception reporting rates which are higher than local and national averages.

This service was placed in special measures in August 2016. Improvements have been made and Groby Road Medical Centre is now rated as good. 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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Groby Road Medical Centre on 24 May 2016. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate checks had not been undertaken to ensure members of the nursing team were registered with the Nursing and Midwifery Council (NMC). The practice had not ensured environmental audits had been carried out in relation to infection control.

• Some emergency medicines were found to be out of date. There was no evidence that a risk assessment had been carried out to ascertain what emergency medicines were and were not suitable for the practice to stock. The practice had not reviewed the risk to service users as there was no process in place to ascertain appropriate emergency medicines were in stock.

• Members of staff were not involved in significant event meetings. Processes for reporting and investigating significant events, incidents and near misses had ceased approximately one year prior to our inspection.

• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.

• Not all risks to patients were assessed and well managed. The practice did not have an up to date fire risk assessment in place. The practice did not have other risk assessments in place to monitor the safety of the premises, staff and service users or for the control of substances hazardous to health (COSHH) and infection control.

• There was no evidence of formal clinical supervision, mentorship and support in place for an Independent Nurse Prescriber for this extended role since qualification.

• The practice had recently expanded the premises to provide additional consulting rooms. Building works commenced in October 2015 and were completed in April 2016. This enabled the practice to recruit additional GPs and improved the availability of appointments for patients.

• The practice had a new partnership in place however, there was limited formal governance arrangements. The practice did not have an effective, documented business plan in place.

• The practice had a proactive patient participation group and had sought feedback from patients.

The areas where the provider must make improvements are:

• Review governance arrangements including systems for assessing and monitoring risks and the quality of the service provision such as implementing a system of clinical audits, gaining assurance that members of the nursing team are registered with the Nursing and Midwifery Council (NMC) and a system of clinical supervision/mentorship for nurse independent prescribers.

• Ensure that there are appropriate systems in place to properly assess and mitigate against risks including risks associated with infection prevention and control, legionella, fire and managing emergency situations.

• Ensure that there are appropriate systems and processes in place in relation to emergency medicines, equipment and clinical supplies in the practice.

• Introduce and embed processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

• Ensure there is a process in place for receiving and disseminating safety updates received from the MHRA and NICE updates to relevant staff and ensuring actions are taken where necessary.

The areas where the provider should make improvements are:

• Ensure a system of appraisals is in place to ensure all members of staff receive an appraisal at least annually.

• Ensure policies and procedures are delivered consistently across the practice.

• Ensure a risk assessment is carried out and rationale documented for not ensuring a DBS check is in place for non-clinical members of staff.

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