This practice is rated as Good overall. (Previous rating February 2018 - Inadequate)

At the February 2018 inspection the key questions were rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

Requirement notices were issued in relation to regulation 16 (receiving and acting on complaints) and 19 (fit and proper persons employed). Warning notices were issued in April 2018 in relation to regulations 12 (safe care and treatment), 17 (good governance) and 18 (staffing). The practice was placed into special measures.

At this November 2018 inspection 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? – Good

We carried out an announced comprehensive inspection at Oldham Medical Services on 9 November 2018. This was a full follow up inspection carried out six months after the report placing the practice into special measures was published. There had been a focussed follow-up inspection carried out on 27 July 2018 to check the progress of warning notices issued. The July 2018 inspection showed that the practice had started to work on the improvements required but further improvement was necessary.

At this inspection we found:

• Recruitment procedures had improved but there was still some information not available for recently employed staff.
• The complaints process had improved and the policy had been updated.
• Safety processes had been improved and all relevant safety checks were carried out.
• Significant events were recorded and investigated and discussed in meetings, so learning could be disseminated.
• Staff training was now monitored for clinical and non-clinical staff. Evidence of training for all staff was held and we saw it was up to date.
• 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.
• The practice team met regularly to review and monitor improvements required.

The areas where the provider must make improvements are:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed. The provider must ensure specified information is available regarding each person employed.

The areas where the provider should make improvements are:

• Improve child vaccination rates.
• Make electronic information relating to complaints accessible to the partners and other managers.

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

Please refer to the detailed report and the evidence tables for further information.

On 16 February 2018 we carried out a full comprehensive inspection of Oldham Medical Services. This resulted in the practice being placed in special measures and Warning Notices being issued against the provider on 3 April 2018. The Notices advised the provider that the practice was failing to meet the required standards relating to Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Safe care and treatment, Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Good governance and Regulation 18 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Staffing.

On 27 July 2018 we undertook a focused inspection to check that the practice had met the requirements of the Warning Notices. We found that although some improvement had been made and some systems had been introduced further improvements were still required to ensure that safety was maintained. In particular we found that:

• The practice introduced a new system for recording significant events. However, we found that there were still further improvements to be made to this system.
• The practice introduced a nationally recognised Sepsis tool into the clinical system and clinical staff had been trained on its use.
• The cold chain was now being appropriately managed and vaccinations were in date.
• Infection control audits had been completed the most recent in 2018 which was conducted by the Local Authority infection control team and scored the practice as 96% compliant, with minor actions recommended which the practice was actioning.
• Fire safety checks were being carried out and included a fire evacuation and testing of emergency lights.
• Emergency medication was stored securely and checks were carried out by the nursing staff.
• We saw monthly checks and records were now being kept for the defibrillator, however we did note that checks had already been recorded for August 2018. Speaking with the practice manager they told us this was an error.
• We saw records were kept for regular locums and now included training. A training record was also maintained for the salaried GP.
• A new locum had been employed to carry our minor surgery within the practice and we saw records of training and qualifications had been obtained.
• A new system was in place for safety alerts including Medicines and Healthcare products Regulatory Agency (MHRA). However, we found that there were still further improvements to be made to this system.
• A Legionella inspection had been carried out in April 2018.
• A newly appointed reception manager had conducted appraisals with reception and administration staff.
• Clinical audits had been initiated by GPs, including a warfarin audit. However, these had not yet been completed.
• We reviewed four complaints received since our previous inspection and found that these had been investigated and responded to in line with policy and procedure.
• The new reception manager had arranged a meeting with the patient participation group (PPG) in May 2018 in which two members attended. The meeting was minuted and noted ideas and suggestions from the PPG members. There was no record as to when or if the group would meet again in the future.
• A meeting schedule has been introduced including monthly partner, clinical and practice meetings. We reviewed the minutes of meetings and saw a record of discussion and actions.
• CQC records showed that an application for a new registered manager had not been received, however an application to add a partner had been received, but rejected in June 2018. Speaking with the practice manager they told us they would resubmit application for new partner once the Disclosure and Barring Service (DBS) had been completed. They believed an application for registered manager had been completed and they would review progress with the partners.The rating awarded to the practice following our full comprehensive inspection on 16 February 2018 of ‘inadequate’ remains unchanged. The practice will be re-inspected in relation to their rating in the future.

The rating awarded to the practice following our full comprehensive inspection on 16 February 2018 of ‘inadequate’ remains unchanged. The practice will be re-inspected in relation to their rating in the future.

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 Oldham Medical Services on 5 March 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.

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. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, although some aspects of the recruitment process relating to Disclosure and Barring Service (DBS) needed strengthening.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they felt listened to by GPs and other staff.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an emergency appointment, although routine appointments were more difficult to access.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

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

Importantly they should:

• All staff should have an appraisal meeting with their line manager.
• A Legionella risk assessment should be carried out and regular testing should take place if appropriate.
• All staff should have training in the prevention and control of infection.
• Record keeping should be improved, including minutes being taken at staff meetings and health and safety walkarounds of the practice being formalised and recorded.
• A Disclosure and Barring Service (DBS) check should be carried out for appropriate staff, including those carrying out chaperone duties.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Inadequate overall. (Previous inspection March 2015 – Good)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

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 – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

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

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

We inspected Oldham Medical Services on 5 March 2015. The practice was rated as good in all domains and overall good. There were some areas where we suggested improvements should be made, but not all these had been carried out. During 2017 an assistant practice manager had joined the practice. They left in October 2017 and the practice manager left in November 2017. The practice had had no manager in place until the current practice manager started work six weeks prior to the inspection.

We carried out an announced comprehensive inspection at Oldham Medical Services on 16 February 2018. This was part of our inspection programme. We found that the overall rating had reduced to inadequate.

At this inspection we found:

• The practice did not have systems in place to manage risk so that safety incidents were less likely to happen. For example the fire risk assessment was not adequate and fire checks were not up to date.

• The infection control audit was not adequate and it had not been identified that some items were not stored hygienically.

• Minor surgery took place approximately every month but the last recorded audit for minor surgery was in June 2013.

• Medicines were not securely stored.

• The cold chain was not effectively monitored.

• When incidents did happen, there was no evidence of learning from them.

• The practice had identified that 300 children had outstanding immunisations but the partners had not been informed of this by nursing or administrative staff..

• There was no evidence new safety guidelines or medicine alerts were disseminated to appropriate staff.

• There was no focus on continuous learning and improvement at any levels of the organisation.

• Staff were not well supported and there was little evidence of appraisal.

• Only 0.2% of patients had been identified as carers and no additional support was offered to carers.

• Not all complaints were investigated and responses to complaints did not contain all the required information.

• The governance in the practice did not support good practice.

• The practice was not correctly registered by the Care Quality Commission (CQC); the registered manager had left and CQC had received no application to register a new one.

The areas where the provider must make improvements are:

• The provider must ensure care and treatment is provided in a safe way to patients.

• The provider must ensure that any complaint received is investigated and any proportionate action is taken in response to any failure identified by the complaint or investigation. The provider must ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.

• The provider must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• The provider must ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

• The provider must ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed. The provider must ensure specified information is available regarding each person employed.

In addition the provider should:

• The provider should take steps to correctly identify patients who are carers so appropriate support can be offered.

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