Archived: Moxley Medical Centre

Updated 31 October 2017

Moxley Medical Centre is a practice located in Wednesbury, an area of the West Midlands. The practice is situated in a purpose built; 2-storey building which was opened in January 2000. The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care and is a nationally agreed contract. The practice also provides some enhanced services such as minor surgery, childhood vaccination and immunisation schemes.

The practice provides primary medical services to approximately 3,200 patients in the local community. The lead GP (male) has the support of a nursing team which consists of one practice nurse and two health care assistants. The non-clinical team consists of administrative and reception staff and a practice manager.

Based on data available from Public Health England, the levels of deprivation in the area served by the practice are below the national average, ranked at two out of ten, with ten being the least deprived. The practice had a lower than national average of patients aged over 65 years, with the practice currently having registered 12% of its population in this age group in comparison to the national average of 17%.

The practice is open to patients between 8am and 6pm on Monday to Thursday and 8am to 12.30pm on Friday. Extended hours appointments are available 6.30pm to 7.15pm on Thursday. Telephone consultations are available if patients requested them; home visits were also available for patients who are unable to attend the surgery. When the practice is closed, primary medical services are provided by Primecare, an out of hours service provider and the NHS 111 service and information about this is available on the practice website.

Updated 31 October 2017

Letter from the Chief Inspector of General Practice

We first inspected, Moxley Medical Centre on 22 November 2016 as part of our comprehensive inspection programme. The overall rating for the practice was inadequate. The full comprehensive report on November 2016 inspection can be found by selecting the ‘all reports’ link for Moxley Medical Centre on our website at www.cqc.org.uk. During the inspection, we found the practice was in breach of legal requirements and placed into special measures. This was because appropriate processes were not in place to mitigate risks in relation to the safety and quality of the services offered. Following the inspection, the practice wrote to us to say what they would do to meet the regulations.

This inspection was an announced comprehensive inspection, carried out on 8 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified in our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the majority of risks had been mitigated and improvements had been made; however further breaches were identified and as a result of our inspection findings the practice is now rated as requires improvement and remains in special measures.

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

• At the previous inspection we found staff immunisation status had not been recorded and no risk assessments had been completed to identify duties undertaken and minimise the risk to staff. We found at this inspection that some immunisation statuses had been documented, however the records were not complete and no risk assessments had been completed in their absence. Since the inspection we have received assurances that all staff have had a review of their immunisation status in relation to their role.
• During our previous inspection in November 2016 we found that processes were not effective to assess, monitor and mitigate the risks relating to the management of medicines with non clinical staff adding new medicines to patients’ records and authorising repeat medicines requested by patients. At this inspection we saw that improvements had been made and processes were in place to ensure all medicines were reviewed and authorised by the GPs.
• We found the service could not demonstrate effective management of risks in relation to medicine safety alerts or updates from the Medicines and Healthcare products Regulatory Agency (MHRA).The practice had a system in place to receive safety alerts, however we found the system to be ineffective and alerts were not always actioned appropriately. Since the inspection, the practice has told us they have reviewed their current procedures for the receiving and actioning of safety alerts and had implemented a system to ensure that all alerts are read and acted on.
• The recruitment of staff was not thorough as we found that conduct in previous employment, such as references had not been sought before staff commenced employment.
• At our previous inspection, results from the national GP patient survey showed patients rated the practice lower than others for several aspects of care. These arrangements had not improved when we undertook the current inspection. The practice with the support of the patient participation group had initiated an in house patient survey, which was being distributed to patients during September 2017.
• There was a clear leadership structure and staff felt supported by management; however effective oversight to ensure governance arrangements were embedded had not been established.
• We found the practice had reviewed the monitoring of emergency equipment and vaccination fridge temperatures since our previous inspection and had introduced a regular recording of checks for all equipment and vaccines.
• A comprehensive business continuity plan had been implemented since the previous inspection so all staff were aware of the procedures to follow if a major incident occurred.
• The manager had implemented administrative team meetings every two weeks and clinical staff meetings on a monthly basis to ensure all staff were kept up to date with changes within the practice.
• At this inspection, we found that all staff had received an appraisal and development plans were in place. A training matrix had been introduced following our previous inspection to monitor staff training and ensure all staff had received the appropriate training relevant to their role.
• Staff understood their responsibilities to raise concerns, incidents and near misses and there was a system in place for reporting and recording significant events. Investigations were discussed with the team to mitigate further risks.
• Arrangements were in place to safeguard children and vulnerable adults from abuse, and local requirements and policies were accessible to all staff.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice proactively sought feedback from staff and patients, which it acted on. The GP encouraged a culture of openness and honesty.

However there were areas of practice where the provider must make improvements:

• 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
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

There were also areas of practice where the provider should make improvements:

• Review how the practice could proactively identify carers in order to offer them support where appropriate.
• Encourage patients to attend national screening programmes.

I confirm that this practice has improved sufficiently to be rated Requires Improvement overall. However, the practice has been rated as inadequate for patients with long term conditions population group and as a result remains in special measures.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 varying the terms of their registration within six months if they do not improve. Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 October 2017

The practice is rated as requires improvement for safe, effective, caring and well led services; this affects all six population groups. Performance for diabetes related indicators is lower than the national average and people with long term conditions has been rated as inadequate.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice worked with the community diabetes specialist nurses to support patients with complex diabetes needs. Performance for diabetes related indicators was 51% which was lower than the CCG average of 93% and the national average of 90%. Exception reporting rate was 5% which was lower than the national average of 11%. Unverified data provided by the practice showed a decline in the 2016/17 QOF data with the practice having achieved 39% for 2016/17.
• Longer appointments and home visits were available when needed.
• Patients had a named GP and an annual review to check their health and medicines needs were being met. The provider had been unable to establish regular meetings with other health care professionals or community teams, but patients were referred for further support where appropriate.
• The practice offered a range of services to support the diagnosis and management of patients with long term conditions.

Updated 31 October 2017

The practice is rated as requires improvement for safe, effective, caring and well led services; this affects all six population groups.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
• Appointments were available outside of school hours and the practice offered a ‘drop in’ clinic with the nurse for children. Baby changing facilities were not available, but staff told us that if this was required an empty room would be offered.
• We saw positive examples of joint working with midwives. The midwife undertook an antenatal clinic every week at the practice.
• Childhood immunisation rates for under two year olds ranged from 98% to 100% compared to the national average of 90%. Immunisation rates for five year olds ranged from 90% to 97% compared to the national average of 88% to 94%.
• There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children.
• The practice’s uptake for the cervical screening programme was 79% which was comparable to the national average of 82%.

Updated 31 October 2017

The practice is rated as requires improvement for safe, effective, caring and well led services; this affects all six population groups.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included blood tests and vaccinations for those patients who were unable to attend the practice.
• The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated.

Updated 31 October 2017

The practice is rated as requires improvement for safe, effective, caring and well led services; this affects all six population groups.

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• The practice offered extended hours to suit the working age population, with late evening appointments available once a week.

Updated 31 October 2017

The practice is rated as requires improvement for safe, effective, caring and well led services; this affects all six population groups.

• The latest published data from the Quality and Outcomes Framework (QOF) of 2015/16 showed 67% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 84%. Unverified data provided by the practice showed they had achieved 100% in dementia related indicators for QOF 2016/17.
• The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations.
• The latest published QOF data of 2015/16 showed 91% of patients on the mental health register had a care plan in place, which was comparable to the national average of 88%.
• The practice supported the Moxley memory club, which was set up to support patients with memory loss and their families.

Updated 31 October 2017

The practice is rated as requires improvement for safe, effective, caring and well led services; this affects all six population groups.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments for patients with a learning disability. Data provided by the practice showed that 12 patients were on the learning disability register. Annual reviews were in place for this patient group, with three patients having reviews completed so far this year. The remaining patients had been invited to attend their review.

• The practice did not meet with other health care professionals in the case management of vulnerable patients and told us they were unable to organise meetings with the district nurses and community teams, but patients who needed further support were referred through the applicable pathways.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations and signposted patients to relevant services available.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.