Archived: The Matthews Practice Belgrave

This practice is rated as Requires Improvement overall and will remain in Special Measures until further improvements have been seen.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Requires Improvement

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 – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people living with dementia) - Requires Improvement

We carried out an announced comprehensive inspection at the Mathews Practice on 24 July 2017. The overall rating for the practice was inadequate, warning notices were issued, and the practice was placed into special measures. An announced focused inspection was carried out on 12 February 2018 which confirmed that the practice had met the requirements of the warning notices issued in July 2017.

This was an announced comprehensive inspection which was carried out on 16 March 2018. This report covers our findings in relation to the practice meeting the requirements of the requirement notices and also additional improvements made since our last inspection.

At this inspection we found:

• The practice was in the process of implementing a complex process of change management in order to make improvements and develop their service.

• The practice have undergone a number of recent and significant changes to their senior management team. For example, GP partnership arrangements had changed because one of the GP partners had stepped down to become a salaried GP and a new Registered Manager had recently been appointed.

• Practice governance arrangements needed to be fully embedded to ensure lasting and positive changes could be sustained within the practice.

• Practice staff needed to contribute to the development and effective implementation of the new practice vision.

• The practice had begun to implement systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, we saw evidence that the practice were learning from them.

• The practice had started to review the effectiveness and appropriateness of the care it provided however data relating to the management of long term conditions was significantly lower than CCG and national averages.

• Staff treated patients with kindness and respect.

• Most patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• There was an improved focus on learning and development across the organisation.

• The practice had taken steps to improve their achievement of the Quality Outcomes Framework (QOF is a voluntary annual reward and incentive programme for all GP surgeries in England, detailing practice achievement results and then rewarding good practice). 

The areas where the provider must make improvements are:

• The practice had a sepsis strategy in place however on the day of inspection a member non-clinical staff we spoke to was not aware of the management of sepsis should a patient present with symptoms.

• Quality outcomes framework data available on the day of inspection identified that the practice was failing in delivering adequate plans and pathways to mitigate risks and thoroughly risk assess the management of long term conditions.  Subsequent QOF data from 2017/18 shows some improvement whereby the practice achieved 519.54 out of 559 points.

• Patient Group Directives (PGD’s) (needed attention to ensure that they were being managed correctly. For example, some documentation was difficult to find because it had been incorrectly filed.
• A number of confidential patient records were being held in an area used for occasional external visitor meetings.  Although these records were stored behind a security coded door we found some of the drawers to be unlocked on the day of inspection.

The areas where the provider should make improvements are:

• The practice had oversight of vulnerable patients and they were discussed at Multi-Disciplinary team meetings however they did not hold dedicated palliative care meetings.

• The branch surgery premises needed attention to improve the general condition of the building and we did not see any plans to address this issue.

• The practice needed to focus on patient access to ensure that the local population are able to gain appointments when necessary.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Mathews Practice on 24 July 2017. The overall rating for the practice was inadequate and the practice was placed in to special measures. The full comprehensive report on the 24 July 2017 inspection can be found by selecting the ‘all reports’ link for The Mathews Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 February 2018 to confirm that the practice had met the requirements of the warning notices which were issued following the inspection on 24 July 2017. This report covers our findings in relation to the practice meeting the requirements of the warning notices and also additional improvements made since our last inspection.

Our key findings were as follows:

• Staff were using up to date protocols and policies to assist them in their work.

• The practice had plans in place to address reported poor telephone access.

• QOF (the Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England, detailing practice achievement results) achievement had been under reviewed and had been improved.

• Long-term condition management had been under reviewed and had been   improved.

• All practice staff had been appraised and had access to relevant continuing professional development.

• Chaperone notices were clearly visible to patients in consultation and treatment rooms.  Staff who acted as chaperones were documenting that they had provided chaperoning duties in the patient record.  (a chaperone is a person who serves as a witness for both a patient and a medical professional as a safeguard for both parties during an intimate medical examination or procedure).

• Most staff felt engaged with how the practice was run.

• Patients that we spoke to felt engaged with how the practice was run.

• The practice were keeping a record of complaints which included the investigations undertaken as a result of complaints received.  Learning from complaints was shared with practice staff to prevent recurrence and improve future performance.

Importantly, the provider should:

• Review and update the practice registration details to ensure that the service is correctly registered and to notify the Care Quality Commission that this has taken place within four weeks of this inspection.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice