Bay Medical Group

We carried out an announced comprehensive inspection at Bay Medical Group on 10 October 2023. Overall, the practice is rated as requires improvement.

Safe - requires improvement

Effective- requires improvement

Caring - good

Responsive - requires improvement

Well-led - requires improvement

We rated the practice as requires improvement for safe, effective, responsive and well-led care because:

• Systems and processes to ensure care was safe were not always operating effectively, the provider had not always identified all risks and could not always demonstrate how they ensured that all required remedial actions had been taken in a timely way.
• Care and treatment for patients with long-term conditions did not always reflect national guidance and childhood vaccination update remained below national averages despite the range of work the provider was undertaking to improve this.
• People were not able to easily get through to the practice by telephone or access appointments in a timely way and the practice complaints process was not fully effective.
• Governance processes were not consistently effective; staffing pressures were impacting on staff wellbeing and the provider had failed to submit statutory notifications to CQC.

During the inspection process, the practice highlighted efforts they were making to improve outcomes and treatment for their population. Some of these were in development so there was not yet verified evidence or data to show effectiveness of these efforts.

Following our previous inspections in 2015, the practice which later became Bay Medical Group were rated good overall with safe, effective, caring, responsive and well-led key questions rated good. Coastal Medical Practice was rated outstanding for providing responsive services because:

• The practice was using a tele-health system to monitor their patients with long-term conditions and taking part in an initiative offering patient’s access to a GP from 8am to 8pm as part of a ‘Prime Ministers Funding Initiative’.

At this inspection, we found that those areas previously regarded as outstanding practice were now embedded throughout the majority of GP practices. The practice continued to develop innovative ways to respond to the needs of the local population. However, 25% of phone calls to the practice had been abandoned in the previous 12 months. The national GP patient survey showed that only 31% of patients responded positively when asked how easy it was to get through to the practice by telephone and the complaints system was not fully effective.

The practice is therefore now rated requires improvement for providing responsive services.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Bay Medical Group on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection in line with our inspection priorities including the age of the last rating.

We inspected and rated all 5 key questions: safe, effective, caring, responsive and well-led.

How we carried out the inspection

We carried out some aspects of this inspection remotely by video conferencing and visited all 5 practice sites on 10 October 2023.

Our remote activity included:

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Reviewing a large range of evidence and documentation from the provider.
• A site visit where we spent time in all 5 branch locations and spoke with GPs, senior leaders, managers, administrative staff and medicines management staff including pharmacists.
• Reviewing surveys completed by Bay Medical Group staff about their work.
• Speaking with 4 members of the Bay Medical Patient Voice Group.
• Reviewing information which patients have shared with CQC.
• Gathering information from partners including Lancashire and South Cumbria Integrated Care Board (ICB).
• Reviewing nationally available data on the practice performance.

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 found that:

• The practice team fully understood the complexities of their practice population and worked innovatively with statutory and voluntary partners to reduce health inequalities in the local area.
• The provider’s systems were not always effective and did not always identify or mitigate all risks to staff and patients. These included premises safety, infection prevention and control, recruitment, incidents, accidents and complaints.
• The practice was not able to answer incoming calls from patients in a timely way, particularly the most critical time each morning. However, access to urgent appointments and triage was available throughout the day and monitored by leaders.
• Most patients received effective care and treatment that met their needs, though our searches identified some areas of long-term condition where the provider was not following national guidance.
• Patient records were not always up to date and complete.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The provider had developed positive development culture with staff empowered to suggest and trial improvement activity to improve patient outcomes.
• The provider had not reported 4 incidents as notifications to CQC in line with statutory requirements.

There were examples of outstanding practice:

The focus on engaging with partners and community groups to reduce health inequalities and promotion of primary care health through social media was demonstrating incremental improvement for people whose circumstances made them vulnerable. This included:

• Improving engagement with people with learning disabilities and encouraging them to attend the practice. The practice had achieved 95% in the reporting year between 1 April 2022 – 31 March 2023 for providing health checks for patients on the practice learning disability register.

• Working effectively with community groups and external partners to promote cancer screening and increasing uptake of bowel, breast and cervical screening.
• The implementation of enhanced health checks for specific neighbourhoods to address health inequalities which was helping raise awareness, understanding and uptake of national screening, vaccination programmes and health checks.

We found 3 breaches of regulations. The provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure that any such action as is necessary and proportionate is taken when any member of staff is no longer fit to carry out their duties.
• Comply with the Care Quality Commission (Registration) Regulations 2009 on statutory notification of incidents.

In addition, the provider should:

• Take action to improve management of incoming telephone calls and reduce abandoned calls.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care