This practice is rated as Good overall. (Previous rating January 2018 – Requires improvement)

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 Seymour Medical Centre on 10 January 2018. The overall rating for the practice was requires improvement and the provider was issued with a warning notice under regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 due to not complying with their legal obligations around fire safety. The full comprehensive report published in March 2018 can be found by selecting the ‘all reports’ link for Seymour Medical Centre on our website at .

This inspection was an announced comprehensive inspection at Seymour Medical Centre on 16 August 2018 to follow up on concerns identified in the inspection on 10 January 2018.

At this inspection we found:

• Systems and processes kept patients safe and safeguarded from abuse.
• 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.
• Fire and electrical risk assessments had been completed and all identified concerns had been rectified.
• The practice 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.
• The practice had identified less that 1% of patients as a carer.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Improve systems to identify patient carers to ensure help and support are being provided to them.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further informa

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall.

(At the previous inspection on the 21 October 2015 the practice was rated as Good overall with requires improvement for the domain of safe.)

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 – Requires Improvement.

People with long-term conditions – Requires Improvement.

Families, children and young people – Requires Improvement.

Working age people (including those recently retired and students – Requires Improvement.

People whose circumstances may make them vulnerable – Requires Improvement.

People experiencing poor mental health (including people with dementia) – Requires Improvement.

At the previous announced comprehensive inspection at Seymour Medical Centre on 21 October 2015 the overall rating for the practice was good with requires improvement for the safe domain. The full comprehensive report on the October 2015 inspection can be found by selecting the ‘all reports’ link for Seymour Medical Centre on our website at www.cqc.org.uk.

We carried out a inspection of this service under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider continues to meet the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The staff had clear roles and responsibilities to support good governance and management. However, we found the provider had failed to meet the requirements made at the previous inspection on the 21 October 2015.

• The provider had failed to carry out a review of the risk assessment to assess and mitigate against the risk of fire dated 1 August 2014  and follow all of the recommendations made. This included the recommendation for an electrical installation check of the premises. The Electricity at Work Regulations 1989, states all commercial properties should be inspected and checked every five years.

• The practice had systems in place to keep patients safe and safeguarded from abuse.

• There was a system for recording and acting on significant events and incidents. Staff understood their duty to raise concerns and report incidents and near misses.

• Clinicians assessed needs and delivered care and treatment in line with current legislation, standards, and guidance supported by clinical pathways and protocols.

• The practice routinely reviewed the effectiveness and appropriateness of the care provided, at the practice meetings.

• Staff had the skills, knowledge, and experience to carry out their roles.

• We spoke with 13 patients who made positive comments about the practice and the GPs. We received 29 patient Care Quality Commission comment cards, 28 were positive about the service experienced.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• The practice involved patients, the public, staff and external partners to support the service.

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

• 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.

The areas where the provider should make improvements are:

• The provider should review the Green Book to ensure they are following the guidance regarding staff immunisations. (The Green book is issued by Public Health England and contains the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK).

• The practice should review the waste management system in the patient’s toilet.

• The provider should review the premises to make sure it complies with the estates, facilities alert regarding window blinds with looped cords or chains. (REF: EAF/2010/007 Issued 8 July 2010).

• The provider should ensure that vaccines are consistently stored following Public Health England Protocol for ordering and storing and handling medication.

• The practice should review the practice list to ensure that carers are correctly identified and on the carers register. 

• The provider should regularly review the patient feedback and where appropriate implement a action plan in response.

• The provider should carry out cinical audits in response to patient issues identified within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Following a comprehensive inspection of Seymour Medical Centre (previously known as Dr S Phillips, Dr M Patel and Dr A Patel) in October 2014, the practice was given an overall inadequate rating and a decision was made to place the practice in special measures. The practice was rated inadequate in the safe, effective, responsive and well led domains and requires improvement in the caring domain. In addition, all six population groups were rated as inadequate.

We carried out an announced comprehensive inspection at the Seymour Medical Centre on 21 October 2015, to consider whether sufficient improvements had been made. The provider had addressed the concerns we had at the inspection on the 20 October 2014 inspection. Overall the practice is rated as good at this inspection.

Specifically, we found the practice to be providing a good service for providing effective, caring, responsive and well led services. However, it required improvement for providing a safe service. It was rated as good for all the population groups.

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, with the exception of those relating to the fire smoke detection alarm system.
• 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 were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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.
• Data showed patient outcomes were comparable to others in the locality. Clinical audits had been carried out, and we saw evidence that audits were driving improvement in performance to improve patient outcomes.

• The practice had a number of policies and procedures to govern activity and these had been reviewed annually.

The areas where the provider must make improvements are:

• Ensure more effective arrangements are in place for monitoring risks associated with fire detection.

The areas where the provider should make improvements are:

• Improve patient outcomes through the measures of the Quality and Outcomes Framework (QOF, is a system intended to improve the quality of general practice and reward good practice).

• Maintain a register of all patients identified as carers.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr S Phillips, Dr M Patel and Dr A Patel on the 20 October 2014. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe, effective, responsive and well led services. It was also inadequate for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students and people experiencing poor mental health (including those with dementia). Improvements were also required for providing caring services.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment and actions identified to address concerns with infection control practice had not been taken. We found that suitable arrangements were not in place for medicines management, infection control, staff recruitment, and dealing with medical emergencies.
• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.
• There was insufficient assurance to demonstrate people received effective care and treatment. For example we found some staff did not have the right qualifications, skills and knowledge to do their job. The learning needs of staff were not fully understood and staff were not supported to participate in training and development to meet their needs.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments and that it was very difficult to get through the practice when phoning to make an appointment.
• The practice had limited formal governance arrangements.

The areas where the provider must make improvements are:

• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks. Including those for medications to ensure they are safe to use, fire safety, business continuity and to ensure that patient group directions are followed.
• Ensure significant events are recorded appropriately and ensure systems are in place to disseminate learning from the discussion and analysis of significant events, with a clear audit trail of these actions.
• Ensure the lead for infection control undertakes training and is able provide advice on the practice infection control policy and carry out staff training.
• Ensure safe systems are in place for the management of medicines. The appropriate action must be taken if fridge temperatures are recorded out of range and staff must be aware of how to take and record temperatures correctly. Monitoring systems must be in place for staff to ensure that the cold chain has not been broken by patients when storing their vaccines at home.
• Review the complaints procedure to highlight patients’ rights in the NHS Constitution and the stages of the NHS complaints process including referral to the Parliamentary and Health Service Ombudsman. Ensure a regular review of complaints takes place and that learning is identified and issues addressed.
• Ensure recruitment arrangements include all necessary employment checks for all staff, including staff who acted as chaperones.
• Provide training for staff to ensure they are equipped with the knowledge and skills to effectively perform their job role.

In addition the provider should:

• Ensure appropriate monitoring and review of the appointments system.
• Review the appraisal system to include objectives for staff to achieve within a specific timeframe.
• Hold regular palliative care meetings with other service providers to plan care for patients with end of life care needs.
• Ensure that all clinical staff are able to demonstrate a clear understanding of Gillick competencies.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

At our previous inspection of this service on the 11 October 2013 we found the practice did not keep records of infection control checks and of some staff meetings. Some patient medical records were also not stored securely.

At this inspection we found the service had met these essential standards of care. There were effective systems in place to accurately maintain records, they were kept securely and could be located promptly when required.

Daily infection control checks were completed by staff.

We spoke to 10 people who used the service and four members of staff. People told us staff were respectful and courteous and gave examples of the service making adjustments for them when needed.

People said, “the doctor explained all the procedures” and “they explain everything in detail.” We found evidence that patients' views were taken into account through the patient participation group. One person said, “They respect your wishes and listen.”

People told us doctors took time to listen and took their history, family history and lifestyle into account when assessing their needs. People said, “They have all my details up on the screen. They ask me about previous visits and any new symptoms” and “I would be dead if it weren’t for the doctor here. They saved my life.” We found evidence that the practice monitored long term health conditions. There were arrangements in place to deal with foreseeable emergencies.

We found there were infection control policies. People we spoke to felt the environment was clean. There were arrangements to deal with clinical and otherwise hazardous waste.

Staff told us they were supported well and we found evidence that they had annual appraisals although some did not have regular supervision. There were regular clinical and practice meetings.

Records we saw were up to date and clear. However, the practice did not keep records of infection control checks or some staff meetings. Some records were not stored securely.