Latham House Medical Practice in Melton Mowbray is a Doctors/GP specialising in the provision of services relating to diagnostic and screening procedures, family planning services, maternity and midwifery services, services for everyone, surgical procedures and treatment of disease, disorder or injury. The last inspection date here was 2nd October 2018
Latham House Medical Practice is managed by Latham House Medical Practice.
Contact Details:
Address:
Latham House Medical Practice Sage Cross Street Melton Mowbray LE13 1NX United Kingdom
This practice is rated as Good overall. (Previous rating November 2017 – Good)
The key questions at this inspection 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 Latham House Medical Practice on 5th September 2018 as part of our inspection programme to ensure the improvements we had seen in November 2017 had been maintained. The practice was inspected in December 2016 where breaches of legal requirements had been found in relation to governance arrangements within the practice. When we inspected in November 2017 we found Latham House Medical Practice to be rated good overall.
At this inspection we found:
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.
Some patients reported long waiting times for appointments or when trying to contact the practice on the phone. The practice were aware of this and trying to implement improved methods for patient access.
The practice had implemented a new management and governance structure to identify responsibilities and create a spine of executive meetings for decisions and discussions to be implemented quickly and effectively. There was an effective system for dissemination of information to the wider team.
The practice emphasised the importance of building relationships with other healthcare agencies by hosting them at the practice to encourage discussions and coordinated patient care.
There was a strong focus on continuous learning and improvement at all levels of the organisation.
The practice management were aware of their limitations due to size and had put in place effective systems to provide effective healthcare for patients. They were future thinking about their practice and how they wanted to evolve patient care.
Staff were proud to work at the practice and the practice had many longstanding members of staff. Staff were well supported at work with management having a genuine interest in their wellbeing. Staff reported Latham House Medical Practice was a family type team.
The areas where the provider should make improvements are:
Ensure the system for prescription stationary includes recording the location within the practice.
Ensure the management of policies at the branch site at Asfordby are reviewed and up to date.
Ensure all emergency equipment and medicines are stored appropriately to reduce risk.
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
We carried out an announced comprehensive inspection of this practice on 7 December 2016. Breaches of legal requirements were found in relation to governance arrangements within the practice. We issued the practice with a warning notice requiring them to achieve compliance with the regulations set out in those warning notices by 5 June 2017. We undertook a focused inspection on 27 July 2017 and found they had met the legal requirements.
The overall rating for the practice following the December 2016 inspection was inadequate and the practice was placed in special measures for a period of six months. The reports for those inspections can be found by selecting the ‘all reports’ link for Latham House Medical Practice on our website at www.cqc.org.uk.
This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 11 October 2017. Overall the practice is now rated as ‘Good’.
Our key findings were as follows:
There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
Risks to patients, for example those from healthcare associated infections were assessed and well managed.
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 was responsive to the needs of patients and tailored its services to meet those needs.
Patients prescribed high risk medicines were well managed and there was an effective re-call system in place for patients with long term conditions.
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.
Patients said there was continuity of care, with quick and easy access to GPs and nurses.
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.
The provider was aware of and complied with the requirements of the duty of candour.
We saw areas of outstanding practice including:
The practice had a confidential and anonymous healthcare and advice service, known as CHAT, aimed at young people under 21 years of age. The practice received no additional funding for the service but was seen as a valuable tool in meeting the healthcare and social care needs of people in this age group.
I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection of this practice on 7 December 2016. Breaches of legal requirements were found in relation to governance arrangements within the practice. We issued the practice with a warning notice requiring them to achieve compliance with the regulations set out in those warning notices by 5 June 2017. We undertook this focused inspection on 27 July 2017 to check that they now met the legal requirements. This report only covers our findings in relation to those requirements.
At this inspection on 27 July 2017 we found that the requirements of the warning notices had been met. Our key findings across the areas we inspected for this focused inspection were as follows:
The practice had made considerable improvements since our last inspection. We saw there was now an effective system in place for reporting, recording and acting on significant events.
Complaints were fully investigated, learning identified and actions implemented.
Clinical audit was used as one mechanism to improve patient outcomes.
The process for the exception reporting of patients had been reviewed and improved.
There was an effective system for receiving, disseminating and acting on safety alerts.
There were arrangements in place for assessing and monitoring risks and the quality of the service provision.
Key policies had had been reviewed and gave GPs and staff guidance to carry out their roles in a safe and effective manner and reflected the requirements of the practice.
There was a clear leadership structure and staff felt well supported.
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection of the practice on 16 April 2015. A breach of legal requirements was found. After the comprehensive inspection the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach of Regulation 12, 13 and 18.
The purpose of this comprehensive inspection was to ensure that sufficient improvement had been made following the practice being given an overall rating of Requires Improvement as a result of the findings at our inspection on 16 April 2015. We also checked that they had followed their action plan from the last inspection and to confirm they now met their legal requirements.
Following this most recent inspection we found insufficient improvements had been made and in some areas had deteriorated which has resulted in the practice being given an overall rating of inadequate. Safe and Well-led are inadequate, Responsive is rated as requires improvement. Effective and Caring is rated as good.
Since our inspection in April 2015 there had been further changes in leadership and although there was a new vision and strategy there was still a lack of accountable, visible leadership.
The process for safeguarding service users from abuse had been reviewed and was now effective.
Patients were at risk of harm because some systems and processes in place were not effective to keep them safe. For example, in the areas of significant events, safety alerts infection control, monitoring of patients on high risk medicines and complaints.
Risks to patients were not assessed and well managed.
The system in place to monitor the training of the GPs and staff within the practice was not effective. For example, not all clinical staff had received appropriate training in safeguarding to ensure they were up to date with current procedures.
Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
The practice had good facilities and was well equipped to treat patients and meet their needs.
Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
Comment cards were positive about the standard of care received. They identified that staff were caring, polite, respectful and professional.
The practice had recently introduced urgent care appointments every morning which were led by a GP and nurse team. These appointments were for patients who wanted to be seen on the day.
There was a limited governance framework to support the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
The areas where the provider must make improvements are:
Improve the process in place for the management of risks to patients and others against inappropriate or unsafe care. This should include reporting, recording, acting on and monitoring significant events, incidents, near misses, patient safety alerts, infection control, monitoring of patients on high risk medicines and complaints.
Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.
Implement governance arrangements to ensure appropriate systems are in place for assessing and monitoring the quality of services provided.
Ensure recruitment arrangements include all necessary employment checks for all staff and are in line with Section 3 of the Health and Social Care Act 2008.
Improve the process in place to ensure staff training is monitored and all staff are up to date with mandatory training.
Ensure CQC registration is up to date and correct in regard to registration of the practice.
Ensure an updated statement of purpose is in place and submitted to the Care Quality Commision.
The areas where the provider should make improvements are:
Ensure actions from infection control audits are recorded and implemented.
Within the Business Continuity Plan ensure mitigating risks and actions are included.
Review and embed the current process to ensure that fridge temperatures at the Asfordby branch surgery are reset in line with practice policy.
Improve the system in place for exception reporting.
Put a system in place to ensure prescription stationery is dealt with in line with national guidance.
Address the issues highlighted in the national GP survey in order to improve patient satisfaction, including in respect of appointment access.
Ensure all staff have a yearly appraisal.
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.
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Latham House Medical Practice on 16 April 2015. Overall the practice is rated as requires improvement.
Specifically, we found the practice to require improvement for providing safe and well led services. It was good for providing an effective, caring and responsive service.
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.
The practice had a system for reporting incidents, near misses or concerns however evidence of learning and communication to staff was limited.
The practice did not have a system in place to ensure an appropriate standard of cleanliness and infection control.
Patients’ needs were assessed and care was planned and delivered following best practice guidance.
Latham House Medical Practice achieved 99.2% of the total QOF target in 2014, which was 1.5% points above CCG Average and 5.7% above national average.
Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
The January 2015 national patient survey showed that 80% of patients would recommend the surgery to others. 86% described the overall experience as good.
The practice did not have a system in place to monitor the learning and development of staff.
The practice encouraged and valued feedback from patients. It had gathered feedback from patients through the patient reference group (PRG), surveys and complaints received.
There was not a clear system in place to identify and monitor staff training.
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.
The areas where the provider must make improvements are:
Embed a system to ensure that staff are aware of and learn from significant events, near misses and complaints.
Embed a system to manage, monitor and review risks to vulnerable children, young people and adults.
Carry out actions identified from risk assessments carried out by the external company in June 2014. Put a policy in place and carry out regular water checks to reduce the risk of legionella.
Embed a robust monitoring system for infection control to include a system of audits and risk assessments where appropriate.
Ensure there is a clear system in place to identify and monitor staff training.
In addition the provider should
Embed a system where risks are monitored regularly to identify any areas that need addressing and discuss at governance meetings.
Have a system in place to ensure audit cycles have been completed.
Provide staff with guidance on whistleblowing.
Ensure actions taken in response to a review of prescribing data is disseminated to all staff including the registrars.
Ensure GP’s due for safeguarding training have undertaken the required updates.
Update the recruitment policy and procedure to contain guidance for staff on the appropriate recruitment checks required prior to employment.
Put a process in place to ensure that the fridge temperatures at the branch surgery are reset daily in line with national guidance.
Update policies to include the name of the responsible person.
Embed a system where themes and trends from complaints are reviewed, discussed and actions taken where appropriate.
©2019 Care Services, all rights reserved. No part of this website may be reproduced without permission of the copyright holders.
