Archived: Shiremoor Medical Group

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 3 March 2016. We rated the practice as inadequate in all five domains of safe, effective, caring, responsive and well-led and the practice was placed in special measures. A new provider, Bridge Medical, was put in place to provide Regulated Activities from 1 April 2016. After the comprehensive inspection, the new provider wrote to us to say what they would do to address the issues raised at the inspection. The new provider has changed the name of the practice to Bridge Medical.

We undertook this comprehensive inspection on 11 October 2016 to check that the practice had followed their plan. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Shiremoor Medical Group on our website at www.cqc.org.uk.

Overall, the practice is rated as good.

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

• The new provider had taken effective steps to make improvements following the last inspection in March 2016; some of the new arrangements were at an early stage and work was still in progress in many areas. They had developed a clear vision, strategy and plan to deliver high quality safe care and promote good outcomes for patients.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. They commented positively on the changes to the practice since the new provider had taken over and on the excellent care they had received from several of the new GPs.
• Information about services and how to complain was available and easy to understand.
• Some patients said they found it difficult to make routine appointments with a GP. There was continuity of care, with urgent appointments available the same day.
• 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 the new management structure and clinical team. The practice proactively sought feedback from staff and patients, which it acted on. Staff told us they had been engaged by the practice to support the changes that had been made. Staff were consistent in their praise of the level of support that was now available from management and clinical staff, they felt that they could raise issues and that there was a no blame culture at the practice.
• The new provider was aware of and complied with the requirements of the duty of candour regulation.
• The new provider was undertaking work to improve the care and support offered to carers, for example, a carer’s policy had been introduced and a carers champion had recently been appointed.

The areas where the provider should make improvements are:

• Complete the process for registering as a provider of regulated activities and for appointing a registered manager for the practice in line with CQC guidance.
• Review the management of complaints at the practice to ensure verbal complaints are taken account of.

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

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 Shiremoor Medical Group on 3 March 2016. Overall the practice is rated as inadequate.

Our key findings were as follows:

• Patients were at risk of harm because the systems and processes in place were weak and ineffective and were not implemented in a way that kept them safe. For example, we found significant concerns in relation to significant events, medicines management and infection control arrangements, recruitment of staff and staffing levels.
• There was insufficient attention given to safeguarding children and vulnerable adults
• The practice did not work effectively with other health and social care services to understand and meet the range and complexity of patients’ needs or to assess and plan ongoing care and treatment. Since October 2015 no palliative care or safeguarding meetings had been held with other healthcare services.
• Patients had concerns about some of the clinical staff. Records showed around 100 patients had stated they did not wish to see a particular GP.
• Services were not delivered in a way that met patients’ needs. Locum GPs provided all GP services; this meant there was little continuity of care for patients. The practice did not have a duty doctor, which meant that on most days between 5pm and 6pm there was no doctor available, despite the practice still being open.
• In the four weeks prior to the inspection three clinics had been cancelled because there were no GPs available.
• Some patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day. However, no home visits were available in the afternoons.
• There was no clinical leadership at the practice and staffing arrangements were unstable.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure arrangements are in place to properly and safely manage medicines, including ensuring prescriptions are handled in line with national guidance issued by NHS Protect. The provider must also take action to ensure effective infection control arrangements are in place.
• Ensure that where the responsibility for the care and treatment of patients is shared with others, that timely care planning takes place. This includes holding regular multi-disciplinary meetings, which ensure the information about the needs of vulnerable and complex patients is shared with other health professionals in a timely manner.
• Ensure appropriate safeguarding systems and processes are in place to prevent abuse of patients, including providing appropriate training for clinical staff.
• Ensure that the system for dealing with complaints is fit for purpose to ensure all complaints are investigated.
• Ensure an appropriate governance framework is in place; to assess, monitor and improve the quality and safety of services, to seek and act on feedback from patients and ensure learning is shared. Staff must have appropriate policies and guidance to carry out their roles in a safe and effective manner.
• Ensure that sufficient numbers of staff are deployed to meet patients’ needs.
• Ensure relevant checks are carried out on staff, in relation to recruitment of new staff.

In addition, the provider should:

• Take action to ensure that looped blind cords or chains are modified or secured out of reach in areas that could be accessed by patients.

We have written to the provider separately to formally advise them of the serious concerns we identified during the inspection on 3 March 2016. The threshold for CQC to take urgent enforcement action was met; however NHS commissioning organisations have put monitoring arrangements in place in the short term that reduce the risks we identified. These commissioning organisations are urgently seeking a long term solution to address these risks. CQC is keeping the situation under review and will escalate matters if a long term solution is not put in place within the near future.

We have received confirmation that a new provider is in place with effect from 1 April 2016.

I am placing this practice in special measures. Practices 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 practice 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 vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice