We previously carried out an announced comprehensive inspection of Moxley Medical Centre on 22 November 2016. The practice was registered as a partnership (Dr Mahamana Vitarana and Dr Miriam Vitarana) at the time of the inspection. The overall rating for the practice was inadequate. The practice was rated inadequate in providing safe and well led services, requires improvement for providing effective and caring services and good for providing responsive services. We placed the practice into special measures.

We carried out another announced comprehensive inspection of Moxley Medical Centre on 8 September 2017. The overall rating for the practice was requires improvement. The practice was rated requires improvement in providing safe, effective, caring and well led services, and good in providing responsive services. Breaches of legal requirements were found and requirement notices were served in relation to safe care and treatment, good governance and fit and proper persons employed. The practice remained in special measures as the long term conditions population group was rated inadequate. The full comprehensive report on the September 2017 inspection can be found by selecting the ‘all reports’ link for Archived: Moxley Medical Centre on our website at .

Moxley Medical Centre was registered as a single-handed provider, Dr Mahamana Vitarana in August 2018. This inspection was an announced comprehensive inspection carried out on 3 October 2018. The inspection was carried out to confirm that the practice met the legal requirements in relation to the breaches in requirements that we identified in our previous inspection on 8 September 2018.

The practice is now rated as Requires Improvement

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Requires improvement

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) – Good

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.
• Improvements had been made to the management of safety alerts and recruitment procedures.
• The practice had systems to keep patients safe and safeguarded from the risk of abuse.
• 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.
• The practice had introduced a structured approach for monitoring patients with long term conditions, which ensured all patients were offered an annual structured review. Although we saw the practice’s performance on quality indicators for long term conditions had improved slightly from the previous year, it was still below the local and national average.
• There was a clear leadership structure and staff felt supported by management; however effective oversight to ensure governance arrangements were embedded had not been fully established. For example: the management of patient group directions, monitoring the prescribing of controlled drugs and ensuring all safety checks had been completed.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients told us they could usually get an appointment when they needed one.
• There was some evidence of systems and processes for learning, continuous improvement and innovation.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards.
• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Periodically review the letters filed by the administrative staff member to check that all significant information in correspondence been highlighted for the GP to action.
• Improve systems for the management of long term conditions.
• Collect information in relation to the Accessible Information Standard (a requirement to make sure that patients and their carers can access and understand the information that they are given.) at the point of registration.

I confirm that this practice has improved sufficiently to be rated Requires Improvement overall. Therefore, I am taking this service out of special measures.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice