Archived: Dr KE Wilcox & Partners Also known as The Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr KE Wilcox & Partners on 2 June 2015. The overall rating for the practice was requires improvement. The full comprehensive report on the June 2015 inspection can be found by selecting the ‘all reports’ link for Dr KE Wilcox & Partners on our website at www.cqc.org.uk.

The inspection carried out on 2 March 2017 found that the practice had responded to some of the concerns raised at the June 2015 inspection. However, we found other breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the practice is inadequate.

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

• There was a system for reporting and recording significant events. However, not all staff understood what constituted an incident or near miss.
• Risks to patients were not always assessed and well managed. For example, those relating to recruitment checks.
• The practice was unable to demonstrate that there was an effective system for receiving and acting on medicines alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).
• The practice did not have an adequate supply of medicines and equipment to respond to medical emergencies in line with national guidance.
• The practice was unable to demonstrate that it had a system to track the use of blank prescription forms throughout the practice.
• Data showed patient outcomes were low compared to the national average. Although some audits had been carried out, we saw no evidence that audits were driving improvements to patient outcomes.
• The practice was unable to demonstrate that all staff had received sufficient training to enable them to carry out their roles effectively, and staff did not have regular appraisals.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it difficult to get through to the practice by telephone and to make an appointment that suited their needs, but that 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.
• The practice had insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure staff receive annual appraisals and are provided with appropriate training to carry out their roles in a safe and effective manner. For example, induction training for new staff, safeguarding, fire safety awareness, basic life support and information governance training.
• Ensure the practice has equipment and medicines suitable for use in a medical emergency.

• Ensure there is a system to ensure that medicines alerts from the Medicines and Healthcare products Regulatory Agency (MHRA) are received and acted upon.

• Ensure the practice has a system for monitoring blank prescription pads and forms throughout the practice.
• Ensure the practice has a business continuity plan that ensures adequate staffing and the long term sustainability of the practice.
• Ensure patients with complex medical needs are discussed at multidisciplinary team meetings, and patients with long term conditions are regularly reviewed and have written care plans.
• Introduce a system to ensure a programme of clinical audit is carried out to drive improvements to patient care by the completion of clinical audit cycles.
• Ensure formal governance arrangements are implemented including systems for assessing and monitoring risks and the quality of the service provision. For example, risks relating to medicines and equipment at the practice for use in an emergency, pre-employment checks and staff training and appraisals.

In addition the provider should:

• Improve staff understanding of what constitutes a significant event, incident or near miss and ensure all significant events are reported.
• Minimise the risk of the refrigerator used to store vaccines being turned off by plugging it directly into a switchless wall socket.
• Proactively identify patients who are carers and support them to access additional support.
• Improve telephone access to the practice and the availability of non-urgent appointments.
• Establish and engage with a patient participation group to provide feedback and support to the practice.

I am placing this service into 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