24/01/2019, 26/02/2019 & 05/03/2019
During a routine inspection
We carried out an announced comprehensive inspection at Steeple Bumpstead Surgery on 26 February 2019. We carried out inspections at the provider’s head office with colleagues from the Hospitals directorate on 24 January 2019 and 5 March 2019.
We previously carried out an inspection at Steeple Bumpstead Surgery on 27 July 2017. At that inspection, we rated the practice as good overall, with requires improvement for providing safe services. We did not identify any breaches of regulation at that time, but we identified where the practice should improve, for example by reviewing the regulated activities for which it was registered and improving outcomes for patients.
This inspection was to follow up on areas where we said the practice required improvement as identified in our inspection of 27 July 2017 as well as to provide new ratings.
We based our judgement of the quality of care at this service on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
This practice is now rated as inadequate overall.
We rated the practice as inadequate for safe because:
- Checks of equipment and premises were not reliable.
- There was a reliance on clinical locum staff but not a consistent and safe approach to managing absences of these clinicians.
- There had not been a multi-disciplinary meeting involving other healthcare professionals since September 2018, despite this being identified as a required action following concerns raised at the end of 2018.
- Prescription stationery and medicines were not held securely.
- There were no systems for clinical support and supervision of staff. There were no documents to define the prescribing remit of the advanced nurse practitioner.
We rated the practice as inadequate for effective because:
- Performance was below average in respect of diabetes, asthma, COPD, cancer and mental health. Identified improvements had not been made following our 2017 inspection.
- Information about patients was not shared with other healthcare professionals at a regular meeting with a view to ensuring continuity of care.
- Information cascades were not effective.
- There was a lack of quality improvement processes in place for example, there had been no clinical audits completed in the last two years.
- The learning and development needs of clinical locum staff were not assessed.
We rated the practice as requires improvement for responsive because:
- Feedback in the GP patient survey was in line with or better than averages in relation to access; however, some patients raised concern about accessing appointments.
- There had been occasions where appointments had to be cancelled by the practice at short notice due to a lack of clinicians.
We rated the practice as inadequate for well-led because:
- The provider was unaware of some challenges to safety and effectiveness at the practice.
- The provider’s vision had not been effectively incorporated into the day to day running of the practice.
- There was limited effective oversight.
- Patients and others were not confident that concerns would be responded to.
We rated the practice as good for caring because:
- Feedback in relation to the care and treatment provided was positive. Patients had trust and confidence in the clinical staff.
The areas where the provider must make improvements as they are in breach of regulations are:
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
The areas where the provider should make improvements are:
- Improve processes for ensuring medical equipment is suitable for use for example, to ensure anaphylaxis packs have a tamper evident seal on them.
- Define and make staff and patients aware of the clinical remit of the advanced nurse practitioner.
- Review the space and environment of the dispensary. Ensure staff are aware of who has overall responsibility of the dispensary.
- Consider mechanisms for obtaining patient feedback such as implementation of an in-house patient survey.
- Review the protocol to offer support to patients affected by bereavement.
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.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care