We carried out an announced inspection at Drs Joseph Borg-Costanzi/Ian Gilani/Brian Rhodes also known as Monton Medical Centre on 26 April 2022. Overall, the practice is rated as inadequate.
Safe - Inadequate
Effective – Requires Improvement
Caring - Good
Responsive – Requires Improvement
Well-led - Inadequate
Following our previous inspection on 7 April 2016 the practice was rated Good overall and for all key questions.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Drs Joseph Borg-Costanzi/Ian Gilani/Brian Rhodes on our website at www.cqc.org.uk
Why we carried out this inspection
This inspection was a comprehensive inspection of all five key questions due to ongoing monitoring of potential risk.
How we carried out the inspection/review
Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.
This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.
This included:
- Completing clinical searches on the practice’s patient records system and discussing findings with the provider
- Reviewing patient records to identify issues and clarify actions taken by the provider
- Requesting evidence from the provider
- A site visit
Our findings
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.
We have rated this practice as Inadequate overall
Following this inspection, we have rated the practice inadequate for providing safe services. We identified the following areas of concern:
- Recruitment checks were not carried out in accordance with regulations.
- Evidence of staff vaccination was not maintained in line with current Public Health England (PHE) guidance.
- There was no system for summarising of new patient notes.
- The practice did not have a system to monitor and record use of prescription stationery.
- Staff using Patient Specific Directions (PSDs) did not have the appropriate authorisations to administer medicines.
- There was no effective system for recording and acting on significant events.
- There was no effective process for managing Medicines and Healthcare Products Regulatory Agency (MHRA) alerts.
Following this inspection, we have rated the practice requires improvement for providing effective services. We identified the following areas of concern:
- The practice did not have a programme of learning and development.
- There was limited monitoring of the outcomes of care and treatment.
We rated the provider as good for providing caring services.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
Following this inspection, we have rated the practice requires improvement for providing responsive services. We identified the following areas of concern:
- People were not always able to access care and treatment in a timely way.
- Complaints were not investigated and there was no evidence that necessary and proportionate action was taken, or learning had taken place or used to improve the quality of care.
Following this inspection, we have rated the practice inadequate for providing well-led services. Concerns included:
- There was not always effective leadership at all levels, for this reason, the practice had plans to recruit to leadership positions.
- The practice had a clear vision and strategy to provide high quality sustainable care, but it was not clear how this was monitored.
- The overall governance arrangements were ineffective.
- The practice did not have clear and effective processes for managing risks, issues and performance.
- The practice did not always have systems in place to continue to deliver services, respond to risk and meet patients’ needs during the pandemic.
- The practice did not always act on appropriate and accurate information.
- The practice did not involve the public and external partners to sustain high quality and sustainable care.
- There was little evidence of systems and processes for learning, continuous improvement and innovation.
We found five breaches of regulations. The provider must:
- Ensure care and treatment is provided in a safe way to patients.
- Ensure that any complaint received is investigated and any proportionate action is taken in response to any failure identified by the complaint or investigation. Ensure that there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
- Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
- Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
-
We also found that the provider should:
- Consider carrying out its own patient survey/patient feedback exercises.
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.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care