Archived: Market Hill 8-8 Centre

Letter from the Chief Inspector of General Practice

INADEQUATE

We carried out an unannounced comprehensive inspection at Market Hill 8-8 Centre on 6 January 2016. Overall the practice is rated as inadequate.

• We identified five breaches of the HSCA (RA) Regulations 2014; two of extreme seriousness and three of high seriousness. These related to safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance and staffing.

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

• Patients were at risk of harm because resources, systems and processes were not in place to keep them safe. For example, sufficient staffing for the smooth running of the service and to fully meet the needs of patients, the management of patients medicines, the call and recall of patients, the system for reviewing hospital discharge and clinic letters, supervision and support of staff and the management of safeguarding. We had serious concerns about the management of all the patients at this practice.
• Not all staff were clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, when there were unintended or unexpected safety incidents, reviews and investigations did not take place or were not thorough enough to support improvement. Action was not taken to mitigate future risk and so safety was not improved. There were no investigation records available and no records to show patients had received a written apology.
• Data, records and feedback from staff showed that care and treatment was not delivered in line with recognised professional standards and guidelines. For example the practice performed significantly below the national average in respect of patients with COPD, asthma, mental health and Osteoporosis.
• Reviews of patient records identified serious concerns with the way patients were managed.
• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.
• We observed members of staff were courteous when speaking with patients. This was aligned with the views of other patients. However, we also noted that patients were not always treated with compassion, dignity and respect by the nature of the complaints received and the very fact that patient’s basic needs were not always being met.
• Patients were unable to always access the care they needed. Services were not set up to support patients with complex needs or patients in vulnerable circumstances.
• Patients were frequently and consistently not able to access appointments and services in a timely way. This included access to emergency appointments. Patients experienced unacceptable waits for some appointments and services. Patients were at risk of harm and poor outcomes because they did not always receive the care they needed.
• The service had little or no clinical governance systems (clinical governance is a system through which healthcare organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish). There was evidence that known risks had not been acted on and despite the known risks, quality monitoring arrangements that had previously been in place had ceased to happen.
• The arrangements for governance and performance management did not operate effectively. The service did not carry out audits to ensure that clinicians working at the service were providing safe and effective care and were given the opportunity to identify opportunities to improve their practice and outcomes for patients. There was no system in place to monitor outcomes of intervention including holding clinicians to account for their clinical decisions. There was no system in place to support peer review and enable shared learning.
• The practice had a fractured staff group with high turnover of staff and had a high number of staff who were off sick. The practice did not have any permanent GPs and used all locum GPs. There was no clinical leadership at the practice and staff were not supervised or competency assessed. We witnessed an apparent high level of stress with at least two members of staff. Lack of support and communication from leaders was a common concern from staff. There was evidence of a defensive and blame culture.

In relation to all of the areas of concern identified, NHS commissioning organisations were informed to ensure any of the risks identified during our inspection were investigated.

Following our inspection, due to the serious concerns identified we urgently varied the conditions of provider’s registration with the Care Quality Commission (CQC) under section 31 of the Health and Social Care Act 2008 and stopped the provider Danum Medical Services Limited (DMSL) from providing GP services at Market Hill 8 - 8 Centre from 12 January 2016. The provider is allowed 28 days to make an appeal against this decision.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice