We carried out an announced comprehensive inspection at Phoenix Medical Group on 18 October 2018. We identified breaches of two legal requirements. A warning notice was issued for one breach of regulation and conditions placed on the provider’s registration for the other. This focused inspection on 6 February 2019 was to check whether the provider had taken steps to comply with the legal requirements of the warning notice and the conditions on their registration against:

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment.
• Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Good governance.

This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Phoenix Medical Group on our website at .

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

• Actions had been taken to address all concerns identified in the breach of regulation and in the conditions placed on the provider’s registration.
• The practice had engaged the help of a number of outside partners to help them improve. This included several different experts from the local clinical commissioning group (CCG) with experience in work flow, cancer referrals, computer services, investigation of significant events and practice management. They engaged with a local cancer charitable organisation for advice.
• They had carried out a major review of the flow of medical correspondence through the practice.
• They had reviewed the process and investigation of significant events.
• They had reviewed their protocol for repeat prescribing and monitoring of high risk medication.
• The system for recording the actions taken in relation to patient safety alerts had been improved.

We are satisfied that the practice has complied with the requirements of the warning notice of 6 November 2018 and is functioning in accordance with the conditions which were placed on their CQC registration certificate on 4 February 2019.

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

This practice is rated as Inadequate overall. (Previous rating March 2018 – Inadequate)

We carried out an announced comprehensive inspection at Phoenix Medical Group on 8 March 2018. We identified breaches of three legal requirements. Requirement notices were issued for two breaches and a warning notice for one breach. On 22 May we carried out an unannounced focused inspection to check whether the provider had taken steps to comply with the legal requirements of the warning notice against:

• Regulation 15 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Premises and equipment.

We found that actions had been taken to address all concerns identified in the breach of regulation.

We carried out an announced comprehensive inspection at the practice on 18 October 2018 to confirm that the practice had carried out their plans to meet the legal requirements in relation to the other two breaches in regulations that we identified in our previous inspection in March 2018, which were;

• Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.
• Regulation 18 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Staffing.

We found that actions had been taken to address the concerns for the breach of regulation 18, most of the concerns in relation to regulation 17 had been addressed, however we identified some new concerns relating to regulation 17.

This report covers our findings in relation to those requirements.

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Inadequate

Are services responsive? – Requires improvement

Are services well-led? - Inadequate

The reports of the March and May 2018 inspections can be found by selecting the ‘all reports’ link for Phoenix Medical Group on our website at .

At this inspection we found:

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses, however we saw these incidents were not fully investigated.
• The practice had systems to keep patients safe and safeguarded from abuse.
• The practice scored lower than the local clinical commissioning group (CCG) average in almost every question in the National GP Patient Survey.
• Staff were consistent and proactive in supporting patients to live healthier lives through a targeted approach to health promotion.
• We saw evidence of staff involving and treating patients with compassion, kindness, dignity and respect. However, patient satisfaction in this area was lower than local and national averages.
• The practice did not comply with the requirements of the duty of candour.
• We were not satisfied with the leadership at the practice and governance arrangements did not operate effectively.

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

• Ensure that care and treatment is provided in a safe way for patients. (See Enforcement Section at the end of this report for further detail).
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Review their arrangements for clinical audit at the practice. Clinical audit should be clearly linked to patient outcomes and monitored for effectiveness.
• Review the satisfaction scores on consultations with GPs in the National GP Patient Survey.

This service will remain in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 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.

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

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

We carried out an announced comprehensive inspection at Phoenix Medical Group on 8 March 2018. We identified breaches of three legal requirements. Requirement notices were issued for two breaches and a warning notice for one breach was issued. This focused unannounced inspection on 22 May 2018 was to check whether the provider had taken steps to comply with the legal requirements of the warning notice against:

• Regulation 15 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Premises and equipment.

This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Phoenix Medical Group on our website at .

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

• Actions had been taken to address all concerns identified in the breach of regulation.
• Security arrangements at the Thornley Surgery had been reviewed and improvements made.
• Controlled stationary was held in accordance with National Guidance.

The areas where the provider should make improvements are;

• Continue to review the arrangements to store healthcare waste in accordance with Department of Health Guidance.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as inadequate overall, At our previous inspection on 2 February 2016 the practice was rated as good overall, but requires improvement for providing safe services)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires Improvement

Are services responsive? – Good

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

The population groups are rated inadequate overall because there are aspects of the practice that require improvement which therefore has an impact on all population groups. There were, however, examples of good practice.

We carried out an announced comprehensive inspection at Phoenix Medical Group on 8 March 2018. This was 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 2 February 2016.

At this inspection we found:

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses.
• Security at the practice was poor and patient’s records were not held securely.
• Health and safety risk assessments had not been carried out or were not followed by the practice
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff were consistent and proactive in supporting patients to live healthier lives through a targeted approach to health promotion. Information was provided to patients to help them understand the care and treatment available.
• Some staff had not received appropriate staff appraisals and some staff training was not up to date.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Generally patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice was aware of and complied with the requirements of the duty of candour.
• The practice were not following their own policies, for example, their recruitment policy.
• We were not satisfied with the leadership at the practice and governance arrangements did not operate effectively.
• The CQC registration was not up to date; the practice had not informed us of changes to partnership at the practice.

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

• Ensure all premises and equipment used by the service provider is fit for use (See Requirement Notice Section at the end of this report for further detail).
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• 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 their duties.

The areas where the provider should make improvements are:

• Review the audit process for exception reporting in QOF.
• Review the satisfaction scores on consultations with GPs in the National GP Patient Survey.

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 this comprehensive inspection on 2 February 2016.

Overall, we rated this practice as good.

Our key findings were as follows:

• The practice provided a good standard of care, led by current best practice guidelines. Clinical audits were used to identify where patient outcomes could be improved.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned. Staff could access a variety of training including in-house and through the Clinical Commissioning Group (CCG). Clinical staff could access protected learning time.
• 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.
• The practice did not always have sufficiently robust recruitment procedures and checks in place for staff.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice actively reviewed their performance in the management of long term conditions, and how these services were provided, for instance to minimise the number of times a patient needed to attend.
• There was a clear leadership structure and staff felt supported by management. Staff felt confident in their roles and responsibilities.

The areas where the provider must make improvement are:

• Ensure appropriate recruitment checks and risk assessments are undertaken as part of the process to employ members of staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We observed the waiting area when patients arrived to reception. We saw that staff dealt with enquiries as discretely as possible to limit the possibility of other patients hearing. One member of staff said “We keep voices to a minimum and if there’s more than one patient at the desk I ask them to stand back.”

We spoke with eight patients. Without exception, the patients said they were very happy with the standard of care they received at the practice. Comments included “It’s very good, excellent”, “I’m pleased with it”, “I think it is an excellent practice with interested and dedicated staff at all levels” and “It’s very good, they are all professional and friendly.”

We saw the practice had safeguarding policies in place for both children and vulnerable adults. There was an identified lead clinician with a clear role to oversee safeguarding within the practice.

We saw the practice was clean, tidy and well maintained. Personal protective equipment and hand hygiene gel was available throughout the practice. Hand washing instructions were also displayed by hand basins and there was a supply of liquid soap and paper hand towels.

We found staff received regular training and supervision. Staff told us they felt supported by their managers.