Bretton Medical Practice

We carried out an announced comprehensive at Bretton Medical Practice on 17 November 2022. Overall, the practice is rated as inadequate.

This is the first inspection of Bretton Medical Practice under the registered provider Bretton Park Healthcare who became the provider from January 2022. Bretton Park Healthcare is the provider of 2 locations, Bretton Medical Practice and Park Medical Practice. We inspected both practices within a 2-day period as both locations were managed by a central team function and both clinical and non-clinical staff worked across both locations.

As a result of the concerns identified we issued a section 29 warning notice on 28 November 2022 in relation to a breach of Regulation 12 Safe Care and Treatment, requiring the provider to achieve compliance with the regulation by 23 January 2023.

Safe - Inadequate

Effective - Inadequate

Caring – Insufficient to rate

Responsive – Requires Improvement

Well-led – Inadequate

The full reports for inspections can be found by selecting the ‘all reports’ link for Bretton Medical Practice on our website at www.cqc.org.uk

Why we carried out this inspection

This was the first inspection of Park Medical Centre in line with our inspection priorities and to follow up concerns reported to us.

How we carried out the inspection.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.
• Staff questionnaires.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

The practice is rated inadequate for providing safe services because:

• There were significant gaps in the practice systems to assess, mitigate, monitor and manage risks to patient safety.
• Not all medicines were prescribed safely to patients.
• The practice failed to have a system and process in place to manage test results, coding of medical records, and patient correspondence to ensure appropriate clinical oversight and action within a timely manner.
• Learning was not always shared, and improvements made and monitored when things went wrong.
• Appropriate recruitment checks for new staff were not always completed.

The practice is rated inadequate for providing effective services because:

• Patients’ needs were not always assessed, and care and treatment were not always delivered in line with current legislation, standards, and evidence-based guidance supported by clear pathways and tools.
• The practice was unable to demonstrate that staff had all the skills, knowledge, and experience to carry out their roles.
• Staff worked with other organisations to deliver effective care and treatment, but patients were not always correctly reviewed in a timely manner.
• Staff were not consistent and proactive in helping patients to live healthier lives. The practice had a significant backlog of patients with long-term conditions who had not been reviewed in the last year.
• The practice had a backlog of patients with a learning disability who had not been reviewed in the last year.
• The practice did not have evidence that staff had received clinical supervision to be assured they were competent to carry out their roles.

The practice is rated requires improvement for providing responsive services because:

• Patients reported difficult getting through to the practice by telephone and accessing an appointment.
• Information of how to make a complaint was not readily available on the practice website.
• Learning from complaints was not always shared with staff.

The practice is rated as inadequate for providing well-led services because:

• There was a lack of leadership and oversight from the provider to ensure services were delivered in a safe and effective way to patients.
• The practice did not have a clear vision and credible strategy to provide high-quality sustainable care.
• The practice culture did not always effectively support the delivery of high quality sustainable care.
• The overall governance arrangements and processes for managing risks, issues and performance were ineffective .
• The practice did not always act on appropriate and accurate information.
• Feedback from the public, staff, and external partners to sustain high quality and sustainable care was not sought or always acted upon.
• There was little evidence of systems and processes for learning, continuous improvement and innovation.

There was insufficient evidence to rate the caring domain. This is because National GP patient survey data was not available to the Commission at the time of this inspection as the practice was newly formed in February 2022. Therefore, in the absence of the practice demonstrating specific caring services or any up to date national or local survey data or sufficient patient feedback we have been unable to rate the provision of caring services.

We found breaches of regulations. The provider must:

• 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.

In addition, there were areas the provider could improve and should:

• Continue to encourage patients to attend for the national cervical screening programme to increase uptake.
• Continue to identify and offer support to carers within the practice.
• Implement and monitor the action plan to improve uptake for learning disability health checks.
• Implement and monitor the action plan to improve uptake for NHS health checks.

I am placing this service in special measures. Services placed in special measures will be inspected again within 6 months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will act 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 6 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.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services