Archived: Moxley Medical Centre

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