We carried out a short notice announced comprehensive inspection at Forrester Street Medical Centre on 11 July 2019 because of information of concern received about the service.
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.
During the factual accuracy period the provider sent us further information relating to safety concerns we raised. However, the information did not address all of the concerns and did not affect the judgement or rating.
We have rated this practice as inadequate overall.
We rated the practice as inadequate for providing safe services because:
- The management of safety systems was not effective particularly in relation to safeguarding, staff training, employment checks and health and safety checks.
- The systems, processes and practice that helped to keep patients safe and safeguarded from abuse were insufficient. The system in place at the practice had not always ensured that all children who did not attend their appointment following referral to secondary care were appropriately monitored and followed up. Not all staff were aware of the practice safeguarding lead.
- The processes for managing information within the practice were not effective. Staff did not have the information they needed to deliver safe care and treatment due to a back log of administrative work.
- The process for monitoring patient’s health in relation to the use of medicines prior to prescribing was not always being followed.
- Not all significant events were reported or investigated and any learning that had been identified was not communicated effectively or embedded into practice.
- There was a lack of a systemic approach for ensuring patient safety alerts had been actioned.
We rated the practice as inadequate for providing effective services because:
- There was a lack of clinical oversight and structured information sharing.
- There was a lack of quality improvement activity.
- Information was not always shared effectively as it was not always available in a timely manner.
- Some performance data was significantly below local and national averages.
We rated the practice as inadequate for providing responsive services because:
- The practice was unable to meet the needs of the practice population.
- Patients were unable to book either same day or pre-bookable appointments when they needed them. Staff were inconsistent with providing advice about alternatives services available to patients.
- Patients found it difficult to get through to the practice on the telephone and often queued to be attended to at the reception desk.
- The premises was not fit for purpose and the planned alterations had not taken place.
- The practice did not document informal comments and complaints and therefore trend analysis and learning could not be derived from these incidents.
We rated the practice as inadequate for providing well led services because:
- There was a lack of leadership within the practice at all levels.
- Not all staff felt valued, supported or safe in their roles.
- There were gaps in the practice’s governance systems and processes and the overall governance arrangements were ineffective.
- The practice had not implemented a clear and effective process for managing risks, issues and performance.
- We saw little evidence of systems and processes for learning and continuous improvement. Not all incidents were reported and investigated and any learning that had been identified was not communicated effectively or embedded.
- The practice did not document informal complaints and therefore trend analysis and learning could not be derived from these incidents.
These areas affected all population groups so we rated all population groups as inadequate.
We rated the practice as requires improvement for providing caring services because:
- Patients did not always feel that they were treated with care and concern, involved in decisions about their care or listened to.
- Patients were not provided with information regarding alternative provision when staff were unable to offer appointments.
- The number of identified carers was below one percent.
- Confidentiality was difficult to maintain in the main reception area.
The areas where the provider must make improvements are:
- Ensure that care and treatment is provided in a safe way.
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
(Please see the specific details on action required at the end of this report).
The areas where the provider should make improvements are:
- Continue to improve uptake of cervical screening.
- Continue to identify carers to enable this group of patients to access the care and support they need.
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