This practice is rated as Good overall. The service was first inspected in November 2015 and rated good overall. It was inspected again in February 2018 and rated inadequate overall.

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 Springfield Medical Centre on 20 August 2018. The inspection was carried out to follow up on breaches of regulations identified during our previous inspection in February 2018. Patients were potentially at risk of harm because systems were not operated effectively manage risks. There were some processes in place for disseminating NICE guidance but there was no evidence of discussion of NICE guidance within the practice. Data from the Quality and Outcomes Framework showed patient outcomes were below local and average such as those for diabetes. There were limited mechanisms in place to review performance and quality of the care delivered to patients.

At this inspection we found:

• The practice had made significant improvements since our previous inspection to improve the service.
• 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.
• The practice had made improvements to its risk management process to keep patients safe, including those for dealing with high risk medicines and patient safety alerts.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment were delivered according to evidence-based guidelines. Minutes of clinical meetings we looked at showed National Institute for Health and Excellence (NICE) guidance was shared and discussed.
• The practice monitored achievement for the Quality and Outcomes Framework (QOF) and had made improvements where identified. Most recent data supplied by the practice showed that QOF achievement was in line with local and national averages.
• Staff involved and treated patients with compassion, kindness, dignity and respect. The practice had worked to improve in areas identified in the national GP patient survey for satisfaction scores for consultations with GPs.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Governance processes were strengthened and we saw action plans in place to review performance and improve quality of the care delivered to patients.
• There was evidence of continuous learning and improvement.

The areas where the provider should make improvements are:

• Encourage patients to join the Patient Participation Group (PPG) in the practice to reflect a range of patient population groups.
• Continue to identify ways in which the uptake of childhood immunisation for under five-year olds could be further improved
• Continue to identify ways to improve cancer screening, particularly for breast screening.

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.

We carried out an announced comprehensive inspection at Springfield Medical Centre on 14 November 2017. The overall rating for the practice was inadequate and it was placed into special measures. The full comprehensive report on the November 2017 inspection can be found by selecting the ‘all reports’ link for Springfield Medical Centre on our website at www.cqc.org.uk.

The overall rating of inadequate will remain unchanged until we undertake a full comprehensive inspection of the practice within the six months of the publication date of the report from February 2018.

This inspection was an announced focused inspection carried out on 6 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations set out in the warning notices issued to the provider.

The warning notices were issued in respect of regulations related to safe care and treatment and good governance. Specifically, the service provider had not done all that was reasonably practicable to mitigate risks to the health and safety of service users receiving care and treatment. This included risks related to arrangements for dealing with emergencies; fire risk; legionella risk; the monitoring of patients being prescribed high risk medicines and the arrangements for the security of prescriptions. The provider had also not ensured that governance arrangements were operated effectively to assess, monitor and improve the quality of services; to assess, monitor and mitigate risks relating to the service and to evaluate and improve the service.

Our key findings were as follows:

• The practice had complied with the warning notices that we issued and had taken action to ensure they met with legal requirements.

• There was a performance improvement plan which was regularly reviewed at clinical and staff meetings.

• There was an improved meeting structure and meeting minutes were easily available to staff.

• The process in place to review and act on safety alerts and Medicines and Healthcare products Regulatory Authority (MRHA) alerts had improved significantly. The policy had been revised and a comprehensive log was maintained to summarise the receipt of incoming alerts, their dissemination and the follow up actions taken.

• A comprehensive fire risk assessment had been carried out by an external company, and recommended improvements made to improve safety. Monthly checks were carried out by practice staff.

• Remedial action had been taken to address medium and low level risks identified in a legionella assessment carried out in February 2015. (high level risks had previously been addressed)

• The process for monitoring patients taking high risk medicines had been strengthened.

• The process for checking the suitability of emergency equipment, including expiry dates of medicines used in an emergency had been strengthened.

• The management of prescription stationary had been improved and locks had been applied to cupboards and printer trays where stationary was stored.

• There was an improved process to monitor and manage uncollected prescriptions.

• Security had improved with regards to storage and access to patient records.

• Action had been taken to rectify a coding error that had resulted in poor QoF achievement for patients diagnosed with depression. Relevant patients now had the correct clinical code applied and were regularly reviewed.

• Improvements had been made to the management of patients diagnosed with diabetes. Data showed that QoF achievement for diabetes related indicators had improved and likely to be in line with CCG averages.

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 Springfield Medical Centre on 11 November 2015. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Learning was shared with the staff throughout the practice so support improvement in the quality of care delivered.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The practice demonstrated good medicines management with regards to the storage and handling of vaccinations and all other medicines including emergency medicines.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.

However there were areas of practice where the provider should make improvements:

The practice should ensure that all clinical audit cycles are completed in order to demonstrate the improvements made to patients’ outcomes.

The Practice should ensure that all prescribing errors are investigated formally in order to ensure continued and shared learning.

The practice should maximise the functionality of the computer system in order that the practice can consistently code patient groups and produce accurate performance data.

The practice should investigate ways to better support patients to feel involved in decisions around their care and treatment.

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 Inadequate overall. (The practice was previously inspected on 11 November 2015 and was rated as good overall)

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 retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

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

We carried out an announced comprehensive inspection at Springfield Medical Centre on 14 November 2017 as part of our inspection programme.

At this inspection we found:

• Systems were in place to enable staff to report and record significant events. Learning was identified.
• Patients were potentially at risk of harm because systems were not operated effectively to keep patients safe including those for dealing with high risk medicines and patient safety alerts.
• A fire risk assessment had not been completed for the premises.
• Actions identified in the practice’s legionella action plan had not been completed.
• Prescription stationery, including blank prescription pads and printer paper, was not stored securely and was not tracked in line with guidance.
• The practice had regular meetings with the health visitor to enable joint working, discussion and review of children at risk. However, safeguarding policies needed to be reviewed.
• There were some processes in place for disseminating NICE guidance. Clinical meetings were held but there was no evidence of discussion of NICE guidance.
• Although some clinical audits had been undertaken there were no clear conclusions drawn and no clear evidence of changes to drive quality improvement in future.

• Data from the Quality and Outcomes Framework showed patient outcomes were below the average for the locality and compared to the national average. Achievement in respect of diabetes and dementia was significantly below local and national averages.
• Data from the national GP patient survey indicated satisfaction scores for consultations with GPs were below local and national averages although scores for nursing staff were in line with or higher than average.
• Patient feedback was positive about access to appointments.
• Information about services and how to complain was available and easy to understand; however, this was not displayed in the patient reception area.
• Complaints had been acknowledged and responded to. We saw that learning from complaints was shared.
• There were limited mechanisms in place to review performance and quality of the care delivered to patients.
• Policies and processes needed to be reviewed to ensure these were fit for purpose and being operated effectively.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was little innovation or service development and improvement was not a priority among staff and leaders.

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

The areas where the provider should make improvements are:

• Review and improve arrangements for the identification of carers
• Review arrangements for the display of information related to making a complaint
• Improve arrangements for the transportation of vaccines

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