Minehead Medical Centre Also known as Harley House

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We rated the practice as inadequate for providing well led services because: Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care. Practice oversight was ineffective to ensure staff remained qualified for their roles and that they worked within their competencies. The practice did not have appropriate systems to identify patients requiring ongoing monitoring of their care and treatment. The practice did not have effective systems to ensure referrals were made without delay and in line with appropriate guidance. The practice did not operate effective processes to ensure incoming documents were reviewed and acted on. The practice was unable to demonstrate they had effective oversight and that practice processes were supported by necessary guidance.

This service scored 14 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they felt supported by practice leaders.

The practice had not implemented processes to identify and manage the challenges or needs of the local population. They had not identified any process to review patient access or staffing levels to ensure they were providing a service which met the needs of patients. Our inspection identified the practice had cultivated a culture where person-centred care was not prioritised.

At our inspection in 2022 we found that there was a disparity of information between staff and leaders. At our inspection in 2023, we found that overall communication regarding the future strategy of the practice had declined. For example, staff were unable identify if actions had been identified to improve access, staffing levels or uptake of national health screenings.

Practice leaders could not demonstrate they were able to appropriately prioritise concerns based on risk. At our inspection in 2022, we had identified a backlog of documents which required processing. At this inspection, the document backlog had increased and staff employed to work through the backlog were not consistently able to work within their role. At the time of this inspection, the practice told us an external company was due to assist in the review of these documents in the new year. However, no actions had been taken or identified to minimise risks to patients in the meantime. Additionally no action plan had been identified to demonstrate how long it would take to work through the historic documents and how they could prevent these events from happening again.

Staff told us they could raise concerns when things went wrong.

At our inspection in 2022 not all staff had completed or were up to date with equality and diversity training. At this inspection, we were unable to determine if improvements had been made as the practice failed to provide us with training records as requested.

The practice did not operate systems that encouraged collaborative working. For example: • Patients were directed to alternative services without proper assessment and effective oversight. • Patients were directed to the minor injuries unit when practice staff were aware they could not always meet the care and treatment requirements of patients due to staffing shortages. • Practice policies cultivated a resistance among practice clinicians to discuss patients receiving care from other services such as paramedics.

The practice did not operate effective processes to identify learning when patient concerns were raised through external stakeholders. For example, the minor injuries unit had raised concerns regarding patients who had been inappropriately referred to their service. Concerns included a patient with a blocked shunt who was directed to MIU by practice staff rather than A&E. (A blocked shunt is when a device used to remove excess fluid in the body, becomes blocked.) The practice had not identified any learning from the incident and maintained that practice staff had acted appropriately.

Triage and escalation processes in practice had not been formalised which meant patients were directed to alternative services without proper assessment, referral and effective oversight.

The practice did not operate systems that encouraged collaborative working. For example: Patients were directed to alternative services without proper assessment and effective oversight. Patients were directed to the minor injuries unit when practice staff were aware they could not always meet the care and treatment requirements of patients due to staffing shortages. Practice policies cultivated a resistance among practice clinicians to discuss patients receiving care from other services such as paramedics.

The practice did not operate effective processes to identify learning when patient concerns were raised through external stakeholders. For example, the minor injuries unit had raised concerns regarding patients who had been inappropriately referred to their service. Concerns included a patient with a blocked shunt who was directed to MIU by practice staff rather than A&E. (A blocked shunt is when a device used to remove excess fluid in the body, becomes blocked.) The practice had not identified any learning from the incident and maintained that practice staff had acted appropriately.

The practice was unable to demonstrate that they had the capability to prioritise improvements. For example: The practice evidenced new protocols they were in the process of drafting to address concerns identified in our previous inspection. However, at the time of this inspection, these improvements were yet to be approved and implemented. The practice advised they had employed a third party company to assist in the management of clinical document workflow in the new year, however there had been no attempts to identify ways to reduce risk to patients and staff continued to be moved away from document workflow to cover other roles.

Systems to identify learning were ineffective. The practice was unable to demonstrate that they identified learning from patient safety concerns and incidents raised through external stakeholders.