1 August 2017
During an inspection looking at part of the service
Letter from the Chief Inspector of General Practice
Letter from the Chief Inspector of General Practice
We carried out an announced responsive comprehensive inspection at Iwade Health Centre on 6 June 2017. The overall rating for the practice was inadequate. The full comprehensive report on the 6 June 2017 inspection can be found by selecting the ‘all reports’ link for Iwade Health Centre on our website at www.cqc.org.uk.
During the announced responsive comprehensive inspection on 6 June 2017 we identified risk of harm to patients due to insufficient staffing numbers, a lack of effective governance processes and systems to identify, assess and monitor risk. This was a breach of legal requirements and the practice was rated inadequate overall. The practice was rated inadequate for providing safe, effective and well-led services, requires improvement for providing responsive services and good for providing caring services.
As a result of the inspection on 6 June 2017 the Care Quality Commission imposed urgent conditions on the registration of the service provider under Section 31 of the Health and Social Care Act 2008, in respect of all regulated activities for which they are registered. This urgent action was taken as we believe that a patient will or may be exposed to the risk of harm if we did not do so. The conditions were imposed on 14 June 2017 and included:
Condition 1: The registered person must not register any new patients at Iwade Health Centre without the written permission of the Care Quality Commission unless those patients are residents of the care and nursing homes attached to Iwade Health Centre or are newly born babies, newly fostered or adopted children of patients already registered at Iwade Health Centre.
Condition 2: The registered person must clear the existing backlogs of repeat prescription requests, medication reviews and Docman correspondence by 27 June 2017.
Condition 3: The registered person must implement a sustainable system to ensure future repeat prescription requests, medication reviews and Docman correspondence are reviewed and actioned without delay, to ensure patients are protected from risk of harm, at Iwade Health Centre.
Condition 4: The registered provider must undertake an urgent review of patient demand to determine the correct level of service provision and resource. This includes all appointment types requested by patients and the reasons for attendance. The review must also include a comprehensive outline of the required levels and numbers of the resource deployed to meet patient needs at all times. The initial review must be undertaken in conjunction with Swale Clinical Commissioning Group, documented and presented in a formal report to CQC by 24 July 2017.
Condition 5: The registered provider must ensure adequate capability, resource and capacity of all staffing groups in order to deliver a safe service. This includes providing adequate clinical staffing and appointments at Iwade Health Centre at all times to protect the health and welfare of patients.
Condition 6: Effective and sustainable clinical governance systems and processes to ensure that all patients are able to access timely, appropriate and safe care must be implemented by 24 July 2017 at Iwade Health Centre. The systems and processes implemented must protect patient safety and enable compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
This inspection was an announced focused inspection undertaken on 1 August 2017 to confirm that the practice had carried out their plans to meet the legal requirements in relation to the breaches in regulations identified, which resulted in urgent conditions being imposed to the providers’ registration, following our previous inspection on 6 June 2017. This report covers our findings in relation to the imposed conditions of registration and will not result in reviewing the overall rating or the ratings of any individual key question or population group.
Our key findings at this inspection, 1 August 2017, were as follows:
We found that none of the urgent conditions imposed on 14 June 2017 had been met.
- We found that condition one of the urgent conditions imposed on your registration had not been met. The registered manager carried out a search of patients registered at the practice since 14 June 2017 and provided documentation which showed that the practice had registered 42 new patients who did not meet the exception criteria.
- We found condition two of the urgent conditions imposed on your registration had not been met. Although there were no urgent repeat prescriptions awaiting action and the backlog of Docman correspondence seen did not pre-date 27 June 2017, medication reviews had not been conducted.
- We found condition three of the urgent conditions imposed had not been met. We saw that there were 36 blood results in a Docman shared inbox from 28 July 2017 to 01 August 2017 which had not been clinically reviewed and had not had any action taken. We reviewed a random sample of two blood results and found patients care had been placed at risk.
- We found condition four of the urgent conditions imposed on your registration had not been met. The registered manager confirmed that the required review of patient demand to determine the correct level of service provision and resource and the resulting report had not been produced.
- We found condition five of the urgent conditions imposed on your registration had not been met. The urgent review of patient demand to determine the correct level of resource and capacity of staffing to deliver a safe service had not been carried out. The expected GP (to cover the lead locum on annual leave) did not attend the surgery on 31 July 2017. Patient appointments were cancelled and rescheduled for the following day. A patient told us that her child’s appointment to see the GP was re-scheduled which resulted in her taking her child to the walk-in service. There were no permanent clinical staff at the practice except the healthcare assistant and the long term locum advanced nurse practitioner left the practice on 31 July 2017.
- We found condition six of the urgent conditions imposed on your registration had not been met. The provider was unable to demonstrate any systems had been employed to address and mitigate the risks to patients and had failed to share the urgent conditions imposed on the providers’ registration with Malling Health (UK) Limited staff and ensure they were adhered to.
As a result of this we sent a Letter of Intention to take urgent action under Section 31 of the Health and Social Care Act 2008 (‘the Act’), which included the power to impose, vary or remove conditions on the providers’ (Malling Health (UK) Ltd) registration. The provider negotiated a termination of contract with Swale clinical commissioning group for 31 August 2017. As a result we removed conditions two to six of those imposed on 14 June 2017 and imposed five further conditions on the registration of the service provider. There are therefore six urgent conditions imposed on the provider’s registration.
Condition 1 of those initially imposed being:
The registered person must not register any new patients at Iwade Health Centre without the written permission of the Care Quality Commission unless those patients are residents of the care and nursing homes attached to Iwade Health Centre or are newly born babies, newly fostered or adopted children of patients already registered at Iwade Health Centre,
and five newly imposed conditions taking account of the current situation at the practice.
Condition 1: The registered provider must work with the appointed incoming provider from the time the notice is served, for the duration of the contract with NHS Swale CCG until it terminates, to ensure patient care is maintained during the period of transition.
Condition 2: The registered provider must clear the backlog of medicine reviews and work with the appointed incoming provider to introduce a sustainable process to ensure this does not reoccur by 25 August 2017.
Condition 3: The registered provider must clear the backlog of prescriptions and work with the appointed incoming provider to introduce a sustainable process to ensure this does not reoccur by 25 August 2017.
Condition 4: The registered provider must clear the backlog of Docman correspondence and work with the appointed incoming provider to introduce a sustainable process to ensure this does not reoccur by 25 August 2017.
Condition 5: The registered person must provide the Care Quality Commission with a schedule of GP and clinical cover delivered by Malling Health (UK) Limited at Iwade Health Centre until the end of your contract with NHS Swale Clinical Commissioning Group by 2pm on 11 August 2017.
We have taken this urgent action as we believe a patient will or may be exposed to the risk of harm if we do not do so.
These conditions are imposed at the following location:
Iwade Health Centre, 1 Monins Road, Iwade, Sittingbourne, Kent ME9 8TY.
The provider Malling Health (UK) Ltd made an application to the Care Quality Commission to vary their conditions of registration by removing the location Iwade Health Centre from all the regulated activities they are registered to provide. The notice of decision to vary the conditions of registration to remove the location Iwade Health Centre was served on the provider on 1 September 2017. Malling Health (UK) Ltd is no longer the provider of regulated activates at Iwade Health Centre.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice