We carried out an announced comprehensive inspection at Grove Medical Practice on 09 April 2019 as part of our inspection programme.

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 good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

• Review policies to ensure they refer to the most current guidance. In particular; review the practice policy for staff vaccinations to ensure staff vaccinations are maintained in line with current Public Health England guidance.
• Review and improve protocol for monitoring vaccine fridge temperatures.
• Consider more formal recording of business strategy.
• Review and improve how signposting information could be included in complaint responses.

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

We carried out an announced comprehensive inspection at Grove Medical Centre on 23 August 2017. The overall rating for the practice was inadequate. The full comprehensive report on the August 2017 inspection can be found by selecting the ‘all reports’ link for Grove Medical Centre on our website at www.cqc.org.uk.

During the inspection we found breaches of legal requirements and the practice was rated inadequate overall. The practice was rated inadequate for providing safe and well-led services, requires improvement for providing caring and responsive services and good for providing effective services. Following this inspection we issued a warning notice that the practice must comply with the legal requirements.

This inspection was an announced focused inspection carried out on 2 February 2018 to confirm that the practice had carried out their plans to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 23 August 2017. This report covers our findings only in relation to the requirements of the warning notices and will not result in reviewing the overall rating or the ratings of any individual key question or population group.

Our key findings were as follows:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• Policies were up to date and easily accessible to all staff.
• Staff had received training appropriate to their job role, the practice maintained an overview of staff training and recruitment checks were completed
• There was a system to ensure that patient safety alerts were acted upon and practice leaders had clear responsibilities for these.
• Patients prescribed high risk medicines were monitored appropriately.

We have seen significant improvement and the service was compliant with the warning notices. The service will be kept under review and remains in special measures. 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 an announced comprehensive inspection at Grove Medical Centre on 10 May 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 10 May 2016 inspection can be found by selecting the ‘all reports’ link for Grove Medical Centre on our website at www.cqc.org.uk.

A subsequent focussed inspection was undertaken on 20 January 2017. The overall rating for the practice remained requires improvement but rated inadequate for being well led. A warning notice was served in relation to the good governance of the practice, Regulation 17.

This inspection was undertaken as an announced comprehensive inspection on 23 August 2017. Overall the practice is now rated as inadequate. Specifically, the practice was rated as inadequate in safe and well led, requires improvement in effective and responsive and good in caring

Our key findings were as follows:

• Staff recruitment checks did not always ensure that evidence was held on file for their employment history and not all staff had references obtained for them.
• Medicine alerts were not acted upon and no evidence was seen that patients were identified as being at potential risk. Patients taking high risk medications were not monitored effectively.
• Although the practice carried out investigations when there were unintended or unexpected safety incidents, lessons learned were not communicated effectively and so safety was not improved. For example there were three significant events featuring wrongly scanned patient information.
• There was insufficient attention to safeguarding vulnerable adults. The practice had different policies in place for this issue which had different information contained within each.
• Non clinical staff had not undertaken training in adult safeguarding.
• Exception reporting for cervical screening was high at 19% and no explanation was given for this(Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
• We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
• Data from the national GP patient survey published July 2017 showed patients rated the practice higher than others for some aspects of care.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• No complaint information was displayed within the reception or waiting room area on the day of inspection but information was available on the practice website. Responses to complaints did not follow the practice’s complaint policy.
• The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active but patients spoken to on the day of inspection were not aware of the group or how to contact it.
• Governance arrangements for the oversight and management of risk had not been sufficiently improved leaving a risk of potential harm to patients and staff. For example, the gas safety certificate had expired in March 2017 and this had been identified within the fire risk assessment undertaken in May 2017, yet it remained unresolved at the time of the inspection in August 2017.
• Risk assessments that had been completed had outstanding actions remaining. For example, corrective pipe work to comply with the legionella risk report of May 2016 was still unresolved and documented in the legionella risk assessment of August 2017.
• While we saw that the provider had taken some action against the warning notice issued in respect of Regulation 17, insufficient progress had been made to manage processes effectively.
• The practice met the warning notice in respect of the management of tracking prescription forms throughout the practice.

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

Importantly, the provider must ensure:

• That recruitment procedures are established and operating effectively to ensure only fit and proper persons are employed. Information relating to Schedule Three must be available for each person employed. .
• Safe care and treatment must be provided in a safe way to patients, including the proper and safe management of medicines.
• That staff employed by the practice must receive appropriate training to enable them to carry out the duties they are employed to perform. In particular adult safeguarding training for non-clinical staff.
• That the practice establishes and operates effectively an accessible system for identifying, receiving, recording, handling and responding to complaints.
• That systems and processes are established and operated effectively to ensure good governance. Including assessing, monitoring and improving the quality of service provided. For example, reviewing the management of significant events. Assessing, monitoring and mitigating risk relating to the health, safety and welfare of patients and staff. For example, reviewing the management of safety assessments, fire risk assessments, Legionella assessments and gas safety.

In addition the provider should:

• Review access to appointments in line with patient feedback.
• Review the management of the cleaning of the practice to ensure that areas of concern are adequately addressed.

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 an announced comprehensive inspection at Grove Medical Centre on 10 May 2016. The overall rating for the practice was requires improvement. The full comprehensive inspection report published on the 3 August 2016 can be found by selecting the ‘all reports’ link for Grove Medical Centre on our website at www.cqc.org.uk. We had found breaches of legal requirements and the provider was rated as requires improvement under the safe, effective and well led domains. The provider was rated good for providing caring and responsive services. The practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring that blank prescriptions forms used within the practice were tracked.

• Ensuring they could demonstrate an adequate method of recording significant events and had a significant event policy in place.

• Ensure all staff that had unsupervised contact with patients, and those used for chaperoning duties, had been checked by the Disclosure and Barring Service or had a risk assessment in place.

• Ensure staff had received all relevant training.

• Ensure that all recruitment checks had been undertaken prior to employing staff.

There were also areas that we found the practice should improve including:

• Actively identifying patients that had caring responsibilities within their patient list.

• Reviewing their complaints procedure to ensure information is available to escalate a complaint should a patient remain dissatisfied.

• Reviewing and updating their business continuity plan.

• Reviewing induction processes to ensure elements are appropriate to different staff groups and document that these are undertaken.

• Reviewing access to appointments in line with patient feedback.

• Ensuring all safety assessments are undertaken and reviewed as appropriate.

This inspection was an announced focused inspection carried out on 20 January 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 10 May 2016.This report covers our findings in relation to those requirements. Although we found that the provider had made some improvements we still found areas where the provider needed to improve.

Overall the practice is still rated as requires improvement.

Our key findings were as follows:

• The provider had ensured all staff that have unsupervised contact, or undertook chaperoning duties, had a Disclosure and Barring Service check in place.

• All appropriate recruitment checks were completed and recorded prior to employment.

• The provider had reviewed their complaints procedure and now provided the appropriate signposting information to patients should they wish to escalate their complaint.

• The provider had updated their business continuity plan but this did not include contact numbers for key staff members.

• The induction process had been reviewed and documentation was seen that the induction process had been followed.

• Areas in relation to access to appointments had improved in the national patient survey feedback.

• The practice had increased the number of known carers from 135 carers to 321 carers.

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

  Importantly, the provider must:

• Ensure governance arrangements for the management of risks to patients and staff such as for, safety assessments, fire risk assessment, Legionella assessment and staff training are complete and known risks are corrected as required.

• Ensure their significant event analysis procedure is complied with and enables all significant events to be managed in a timely manner..

• Ensure their recording system in place to track prescription forms used within the practice allows for the correct tracking of all prescription forms.

• Ensure all staff receive appropriate training commensurate to their role, for example, fire training, information governance and Mental Capacity Act (2005) (MCA).

• Ensure that safety assessments are undertaken as required and ensure that they formulate an action plan to address the issues that have been documented.

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 Grove Medical Centre on 10 May 2016. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety however, systems in place for reporting and recording significant events required improvement.
• Risks to patients were assessed and managed although there were some shortfalls in relation to staff who acted as chaperones. These staff had not been Disclosure and Barring Service (DBS) checked. Also the method of prescription form tracking required improvement.
• 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.
• There were some gaps identified in staff training, particularly for fire safety, information governance and Mental Capacity Act (2005) training.
• Patients said they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.
• 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 had a number of policies and procedures to govern activity, but some were overdue a review.
• Urgent appointments were usually available on the day they were requested, but some patients said that it was difficult to make an appointment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

The areas where the provider must make improvements are:

• The provider must review their significant event analysis procedure to ensure that the documentation of these issues are complete.

• The provider must maintain and ensure a recording system to track prescription forms is embedded within the practice.
• To ensure staff whose role means they have unsupervised contact with patients are appropriately checked via the Disclosure and Barring service or that a risk assessment is in place detailing how this has been considered to ensure patient safety..
• To ensure all recruitment checks are completed prior to employment and that records of these checks are maintained.
• To ensure all staff receive appropriate training commensurate to their role.

In addition the provider should:

• Actively identify patients that have caring responsibilities within the patient list.

• Review the complaints process to ensure all patients are given the information on how they can escalate their complaint if they remain dissatisfied and furthermore the practice should ensure verbal complaints are recorded.
• Review and update their business continuity plan.
• Review their induction process to ensure all elements are appropriate for each staff role and that these are recorded.
• Review access to appointments in line with patient feedback regarding this aspect.
• Ensure that all safety assessments are undertaken and reviewed as required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating August 2017 – Inadequate)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Grove Medical Centre on 12 April 2018, to follow up on breaches of regulations identified at our inspection in August 2017. At a previous inspection, August 2017, we rated the practice inadequate for providing safe and well-led services, requires improvement for providing effective and responsive services, and good for caring.

We issued warning notices in respect of these issues and found arrangements had significantly improved when we undertook a follow up inspection of the service on 2 February 2018. The details of these can be found by selecting the ‘all reports’ link for Grove Medical Centre on our website at www.cqc.org.uk

At this inspection we found:

The practice had addressed all concerns that were identified at our previous inspections.

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

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

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice