Crown Heights Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crown Heights Medical Centre on 29 November 2016 to assess the improvements made at the practice. Overall the practice is now rated as requires improvement

We had previously inspected on 4 May 2016 when we rated the practice as inadequate overall. Specifically, the practice was rated as inadequate for safe and for well-led, and requires improvement for effective, caring and responsive.

Areas which did not meet the regulations following our inspection in May 2016 were:

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment and actions identified to address concerns with infection control practice had not been taken.
• There was no evidence of learning and communication with staff about reported safety incidents.
• Appointment systems were not working well so patients did not receive timely care when they needed it. This was particularly around the ineffective phone system at the practice that was not sufficient to keep up with the volume of patient calls.
• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.
• Patient complaints were not consistently investigated or responded to.

On 29 November 2016 our key findings across all the areas we inspected are as follows:

• There was a new approach to the running of the practice with an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Risks to the safe care of patients were more clearly managed, with the exception of the storage of vaccines.
• Staff assessed patients who attended the practice had their needs and delivered care in line with current evidence based guidance. However, not all patients with long term care needs had a regular assessment.

• Staff had received updated training and had the skills, knowledge and experience to deliver effective care and treatment.

• Information about services and how to complain was available and easy to understand. Complaints were investigated appropriately and in a timely manner.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a clear leadership structure and staff felt supported by management.

• The practice proactively sought feedback from staff and patients, which it acted on. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The provider was aware of and complied with the requirements of the Duty of Candour.

However, there remain areas where the provider must make improvement. The practice must:

• Ensure safe systems are in place for the storage of vaccines.

• Regularly review the needs of patients with long term conditions to ensure care and treatment is safe and appropriate.

There was also an area where the practice should make improvement:

• Increase the involvement and satisfaction of patients in planning and making decisions about their care and treatment

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crown Heights Medical Centre on 4 May 2016. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment and actions identified to address concerns with infection control practice had not been taken.
• There was no evidence of learning and communication with staff about reported safety incidents.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity. However, some patients we spoke to reported that they felt their long term conditions and mental health were not taken seriously by all staff at the practice.
• Appointment systems were not working well so patients did not receive timely care when they needed it. This was particularly around the ineffective phone system at the practice that was not sufficient to keep up with the volume of patient calls. Patients told us that they could be on hold for up to half an hour before speaking to a receptionist.
• Patients had access to leaflets and online links to a wide range of support groups available in the local area.
• The practice had an above average uptake for the cervical screening programme (93%, Clinical commissioning group 81%, national average 82%).
• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

• Ensure there are processes for sharing of learning as a result of significant events, incidents and near misses.

• Take action to address identified concerns with infection prevention and control practice including, understanding of the use and maintenance of specialist equipment.
• Ensure adherence to processes in place for the management of blank prescription pads.
• Ensure recruitment records include all necessary employment checks for all staff.
• Ensure all staff have received the relevant training for their role.
• Ensure patients with long term conditions have their health needs met.
• Ensure patient information is in formats suitable for the patient group.
• Ensure patient feedback is encouraged. Ensure there is an effective and representative Patient Participation Group in place.
• Patient complaints must be reviewed and responded to.
• Ensure there are formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

The areas where the provider should make improvement are:

• Improve the processes for patients to make appointments and arrangements for patients who work to have access to a GP appointment outside of normal hours.
• Ensure carers are identified by the practice to enable them to have the support they might need.

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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice