Archived: Mevagissey Surgery

In light of the current Covid-19 pandemic, CQC has looked at ways to fulfil our regulatory obligations, respond to risk and reduce the burden placed on practices by minimising the time inspection teams spend on site.

In order to seek assurances around potential risks to patients, we are currently piloting a process of remote working as far as practicable. This practice consented to take part in this pilot and the evidence in the report was gathered without entering the practice premises. The assessment did not include an on-site inspection and therefore ratings from our previous inspection have not been reviewed.

Background

• We carried out an unannounced responsive comprehensive inspection at Mevagissey Surgery on 12 and 13 February 2020 following information received from stakeholders and a review of the information available to us.

• The practice was rated as inadequate overall and was placed into special measures. The practice was rated inadequate for the provision of safe, effective and well-led services, and for all population groups. The practice was rated as good for providing caring services and requires improvement for the provision of responsive services.

• We issued the provider with requirement notices for breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, related to safeguarding service users from abuse and improper treatment; staffing; and fit and proper persons employed.

• We also issued the provider with warning notices for breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, related to safe care and treatment and good governance.

• Following the inspection, we issued the provider with a notice of decision to place conditions on their registration. Due to the risks associated with the outbreak of the Covid-19 pandemic we were not able to undertake our planned focused inspection to follow up on the warning notices issued from the February 2020 inspection. Instead, we have continued to monitor the provider’s progress against their action plan which included regular meetings and/or communication with the provider and fortnightly meetings with Kernow Clinical Commissioning Group, as well as reviewing and responding to information received from patients and staff employed at the practice.

• Through our ongoing monitoring we did not gain the assurances required around progress against the action plan that the provider had submitted in order to ensure patient safety and as such we issued a notice of decision to apply further conditions to their registration on 9 June 2020.

Information submitted to CQC on 20 July, in accordance with a condition of the notice of decision issued 9 June 2020, did not provide assurances that the condition had been met.

To gain further assurances we undertook a remote regulatory assessment on 10 and 11 August 2020. During the assessment we reviewed Mevagissey Surgery’s clinical records system which included the practice’s task management system and a sample of patient’s electronic records.

We found that:

• There continued to be significant delays in the completion of the full review of patients with long-term conditions.
• Staffing levels were not sufficient to meet the daily and long-term needs of patients registered at Mevagissey Surgery and the branch surgery of Gorran Haven.
• There was a significant delay in the completion of daily tasks, resulting in delays in care and treatment of up to eight weeks, exposing them to the risk of harm.

Following the assessment undertaken on 10 and 11 August 2020, we issued the provider with a notice of decision to apply additional conditions to the registration. Those conditions were regarding the timely review and monitoring of patients with long-term conditions; the timely processing of daily task management, and sufficient staffing levels to meet the daily and long-term needs of patients registers at the practice.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an unannounced responsive comprehensive inspection at Mevagissey Surgery on 12 and 13 February 2020 following information received from stakeholders and a review of the information available to us.

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. All population groups are rated as inadequate overall.

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

• Systems and processes do not keep patients safe.
• Clinicians did not have access to consultation history and previous clinical actions to ensure they were able to deliver safe care and treatment.
• The practice did not have appropriate systems in place for the safe management of medicines.
• The practice did not learn and make improvements when things went wrong. Safety is not a sufficient priority.
• Patients were at risk of harm or abuse as background checks had not been carried out on staff in clinical roles.

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

• There was limited monitoring of the outcomes of care and treatment.
• The practice was unable to show that staff had the skills, knowledge and experience to deliver good quality care.
• There was limited monitoring of patient’s outcomes of care and treatment. Patient’s outcomes were worse than expected when compared with similar services. Necessary action was not being taken to improve these outcomes. The practice did not have adequate systems in place to monitor, review and provide care and treatment for patients.
• Some performance data was significantly below local and national averages, which showed that patients were not being supported to live healthier lives.

We rated the practice as inadequate for providing well-led services because:

• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
• While the practice had a vision, that vision was not supported by a credible strategy.
• The practice culture did not effectively support high quality sustainable care.
• 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 act on appropriate and accurate information.
• There was minimal evidence of systems and processes for learning, continuous improvement, innovation or reflective practice.

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

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.

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

• Staff lacked the relevant knowledge to book patients in with the appropriate clinician resulting in delays to appointments.
• Patients were not able to access care and treatment in a timely way.
• Complaints and concerns were not handled appropriately. Patient’s concerns did not lead to improvements in the quality of care.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Ensure patients are protected from abuse and improper treatment.
• 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, supervision and appraisal necessary to enable them to carry out the duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Improve uptake of cervical screening.
• Improve identification of registered patients who are carers.

Following this inspection, we undertook enforcement action against the provider, Veor Surgery.

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