We carried out an announced comprehensive inspection at Albert Road Surgery (Dr Winifred Helen McManus) on 15 May 2019 as part of our inspection programme, and to follow up on breaches of regulations identified at a previous inspection on 27 September 2018. Previous ratings:
- June 2015 – comprehensive inspection, rated as good overall but requires improvement for providing safe services
- December 2017 - focused inspection, remained rated as requires improvement for safe
- September 2018 – comprehensive inspection, rated as requires improvement for providing safe and well led services and overall.
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.
We have rated this practice as inadequate overall. We have rated all population groups as requires improvement.
We rated the practice as inadequate for providing safe services because:
- While the practice had made some improvements since our inspection on 27 September 2018, it had not appropriately addressed the Requirement Notice in relation to ensuring that staff had received the immunisations appropriate to their role. At this inspection we also identified additional concerns that put patients at risk. For example:
- Appropriate standards of cleanliness and hygiene were not met.
- There were gaps in systems to assess, monitor and manage risks to patient safety.
- The practice did not have appropriate systems in place for the safe management of medicines.
We rated the practice as inadequate for providing well-led services because:
- While the practice had made some improvements since our inspection on 27 September 2018, they had not appropriately addressed the Requirement Notice in relation to the implementation of systems to assess, monitor and mitigate risks to service users.
- There was still no detailed strategy or vision for how the practice was going to address staffing concerns.
- Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
- The practice did not have a clear vision, supported by a credible strategy.
- The overall governance arrangements were ineffective.
- The practice did not have clear and effective processes for managing risks, issues and performance.
- We saw little evidence of systems and processes for learning, continuous improvement and innovation.
We rated the practice as requires improvement for providing effective services because:
- The practice did not have a systematic programme of quality improvement.
- There was a lack of guidance available for the locum GPs in relation to clinical guidelines and prescribing protocols.
- Staff appraisals did not assess the learning and development needs of staff.
- There were no records to demonstrate the training undertaken by the lead GP.
We rated the practice as good for providing caring and responsive services because:
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
- The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
The areas where the provider must make improvements are:
- Ensure that care and treatment is provided in a safe way.
- Ensure all premises and equipment used by the service provider is fit for use.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
(Please see the specific details on action required at the end of this report).
The areas where the provider should make improvements are:
- Provide appropriate training for non-clinical staff on sepsis awareness.
- Maintain records of all staff’s training.
- Take steps to review patient safety alerts issued during the practice manager’s absence and take action as appropriate.
- Implement a system to keep all clinicians up to date with current evidence based practice.
- Review the contents of the locum pack to ensure all necessary guidelines and up to date information is available.
- Take action to ensure that patients who need support to access the premises can summon assistance.
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.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care