Archived: Phoenix Surgery

In September 2018, Phoenix Surgery began working collaboratively with five other practices in the Swindon area with the support of Integral Medical Holdings (IMH), who provide back-office services such as payroll, Human Resources, finance and management support. This collaboration was formed to maintain the services provided by these practices, and to look to develop new ways of working in line with the Government’s plan for primary care, the ‘General Practice Five Year Forward View’. The group is now known as the Better Health Partnership following a change of registration with CQC in March 2019. This was predominately a business and legal entity change with the same people being responsible for the running of the practice with the old provider IMH.

We carried out an announced comprehensive inspection at Phoenix Surgery on 30 April 2019 as part of our inspection programme.

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.

We rated the practice as inadequate for providing safe services because:

• Fire drills had not taken place and fire marshals had not been identified.
• The practice did not have clear systems and processes to keep patients safe.
• Safeguarding training was overdue for some staff.
• A back log of correspondence was identified and had not been processed in a timely way at the Morden Medical Centre HUB. This resulted in delays to care and treatment for patients.

We rated the practice as requires improvement for providing effective services because:

• The programme of annual reviews of patients with long term conditions, mental health needs and dementia was ineffective in that patients did not receive timely reviews and there was a risk their health needs would not be met. Recent data under the new provider showed achievement was still below the Clinical Commissioning Group and national averages. There were limited plans in place which gave assurance that improvements would be sufficient and sustained.
• There was limited evidence of complete cycle clinical audits and quality improvement.

We rated the practice as inadequate for providing responsive services because:

• Access to the practice through the Morden Hub and appointments was difficult for patients. Some patients told us they sometimes found it difficult to access appointments through the new hub-based telephone system.
• Complaints received from Phoenix patients were not responded to in a timely way or used to identify improvements to the service.

We rated the practice as inadequate for providing well-led services because the delivery of high-quality care is not assured by the leadership, governance or culture.

• The provider stated they did not have a vision and values in place which had been shared with the staff at Phoenix Surgery.
• The overall governance arrangements were ineffective. In particular, the management of risks and issues had not been effectively implemented; and we found significant failures in performance management and audit systems and processes in relation to clinical issues.
• The practice did not currently have a practice supervisor in place and some staff felt unsupported.
• The practice did not have a patient participation group.
• Feedback from relevant persons and patients around service failures was not effectively addressed and did not lead to positive sustainable change.

We rated people with long term conditions, older people, working age people, people whose circumstances make them vulnerable, families children and young people and people experiencing poor mental health as inadequate.

We rated the practice as good for and caring services because:

• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients we spoke with, CQC comment cards and other feedback showed us that patients had positive views of this service.

The areas where the provider must make improvement 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).

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 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