This practice is rated as Inadequate overall. This rating was given at our previous inspection 14 December 2017.

We carried out an unannounced focused inspection of Leicester Medical Group on 10 April 2018. This inspection was undertaken to follow up on breaches of regulations which had been identified at our previous inspection in December 2017 in relation to safe care and treatment and governance arrangements within the practice. We issued the practice with two warning notices requiring them to achieve compliance with the regulations set out in those warning notices by 14 March 2018. This focused inspection only included the safe and well led key questions.

At this inspection we found that all the requirements of the two warning notices had not been met. Additionally we found further serious concerns.

Our key findings across the areas we inspected for this focused inspection were as follows:

• Patients were at risk of harm because there was a lack of monitoring of the care and treatment of patients.
• There was a failure of some clinicians to treat patients in accordance with national clinical guidelines and we found examples of poor care and treatment which put patients at serious risk of harm.
• There were 38 outstanding tasks on the practice computer system dating back to mid-March 2018. This put patients at risk of delays in diagnosis, further investigation and treatment. One patient had not been informed that their test results indicated a diagnosis of diabetes.
• There was not an effective system to summarise patient records. We found 356 patient records in different areas of the practice which were waiting to be summarised. The practice were unaware of how many records were not summarised or how to identify this and therefore unable to say how long the records had been unsummarised. This put patients at risk as summarising patient records protects patients by ensuring that relevant and key information about patients is recorded and therefore available should another clinician need to refer to those records in order to ascertain what would be safe care and treatment for a particular patient.
• Actions had been taken to improve the system for safeguarding children but the system still required strengthening.
• At our inspection in December 2017 there was not a clear and effective system for reporting and acting on significant events. We found this was still the case which meant the practice did not have adequate systems to prevent or minimise the risk of safety incidents recurring or identifying and sharing learning from them.
• We found that not all blank prescription forms were kept securely.
• At this inspection we still had concerns with regard to the clinical oversight and governance arrangements in place.
• Performance of employed clinical staff could not be demonstrated through audit of their consultations, prescribing and referral decisions.
• The practice did not have effective systems to support the appropriate and safe management of medicines.
• During the course of our inspection we found out of date medicines in the practice and medicines which were not stored safely and could be accessed by patients. We also found confidential patient information which was accessible to patients in unlocked rooms.
• Medicines were administered to patients without relevant authorisation by a GP.
• Patients’ health was not always monitored in a timely manner to ensure medicines were being used safely and followed up on appropriately.

The provider is no longer providing care or treatment from Thurmaston Health Centre.

As a result of the inspection team’s findings from the unannounced focused inspection, as to non-compliance, but more seriously, the risk to service users’ life, health and wellbeing, the Commission decided to issue an urgent notice of decision to impose conditions on the provider’s registration to stop them carrying on regulated activities from this location under section 31 of the Health and Social Act 2008. The notice was served on the provider on 11 April 2018 and took immediate effect which means the provider is no longer able to carry on regulated activities from Thurmaston Health Centre, 573a Melton Road, Thurmaston, Leicester LE4 8EA.

The practice is still open but services are being provided by a different provider.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Thurmaston Health Centre on 14 December 2017. The practice is rated as good for responsive and caring, requires improvement for effective and inadequate for safe and well-led. Overall the practice is rated as inadequate.

All six population groups;

• Older people:
• People with long term conditions:
• Families, children and young people:
• People whose circumstances make them vulnerable:
• Working age people (including those recently retired and students):
• People experiencing poor mental health (including people with dementia):

are also rated as inadequate as these ratings applied to everyone using the practice including all population groups.

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

• When serious incidents happened the practice had not ensured that the staff and GPs involved had learned from the events or that the learning was communicated to staff in an effective manner.
• Patients had not always been reviewed to ensure medicines were prescribed safely.
• Patients in receipt of medicines prescribed through secondary care providers did not have those medicines clearly identified on their records, posing a risk of inappropriate prescribing.
• The provider had not taken steps to ensure that medicines requiring refrigeration were kept safely to ensure their efficacy.
• The process for monitoring the temperature of fridges used to store medicines was inadequate and posed the risk that the medicines may not be effective.
• Some medical equipment and medicines had passed the manufacturers use by date.
• The provider had an infection prevention and control policy and had recently completed an audit, however we found the practice to be untidy and cluttered in some areas.
• Patient safety alerts and guidance from bodies such as the National Institute for Health and Care Excellence was received into the practice and cascaded to relevant staff but we found the process was informal and not well documented.
• There was no evidence that the provider had always undertaken the appropriate checks before staff started working at the practice.
• The provider did have effective processes in place to monitor performance.
• We had concerns that the partner who ran this practice and was also the registered manager was over-stretched and had insufficient time to ensure good governance.
• The providers safeguarding process was not embedded and there was an absence of meetings with other interested parties.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a lack of information to help support carers.
• The provider had taken positive steps to help reduce isolation in older people and to provide continuing support to people following bereavement.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Following our inspection we contacted the clinical commissioning group who carried out their own visits to the practice.

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.
• Ensure patients are protected from abuse and improper treatment.
• Maintain appropriate standards of hygiene for premises and equipment.
• Ensure all premises and equipment used by the service provider is fit for use.
• Ensure specified information is available regarding each person employed.
• Undertake quality improvement initiatives to help improve patient outcomes.

The areas where the provider should make improvements are:

• Have in place an effective system to provide assurance that staff have access to and are made aware of patient safety alerts and clinical guidance.
• Have in place information for carers on how to access support services.

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 Thurmaston Health Centre on 18 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was good for the all of the population groups.

• The majority of patients we gathered information from on this inspection indicated they were satisfied with the service provided, that they were treated with dignity, respect and care, and that staff were thorough, professional and approachable.
• The practice operated a system whereby all patients were offered either a telephone or face to face consultation with a clinician on the day they telephoned for an appointment.
• The practice provided a good standard of care, led by current best practice guidelines, which clinical staff routinely referred to.
• People with conditions such as diabetes and asthma attended regular clinics to ensure their conditions were appropriately monitored, and they were involved in making decisions about their care.
• The practice shared information appropriately with other providers, such as out of hours care providers, to ensure continuity of care to patients.
• The practice had good facilities which were kept safe, and were well equipped to meet patient need.
• The building was spacious, clean, and the risk of infection was kept to a minimum by systems such as the use of single use disposable instruments.

Areas for improvement.

Action the provider SHOULD take to improve

• Whilst serious incidents and complaints were well investigated and action taken as a result of any learning, there were no annual reviews to help identify any trends.
• The practice should ensure that all internal staff meetings and meetings with other healthcare professionals are fully recorded.

Outstanding Practice

• The practice had implemented a system for patients to access same day clinical consultations. This had reduced the wait for patients to see a GP or other healthcare professional from an average of 5.5 days to one day. All patients who telephoned the practice either got a face to face or telephone consultation on the day they called. Pre-bookable appointments were still available for health reviews and less urgent matters.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice