We carried out an announced comprehensive inspection of Moredon Medical Centre on 27 February 2020 as part of our inspection programme, and in line with our published regulatory processes. A new provider, Great Western Hospitals NHS Foundation Trust, took over responsibility for the location, Moredon Medical Centre, in November 2019.
The inspection was a comprehensive follow up of the Special Measures imposed in March 2019 under the previous provider arrangements, and to follow up on the urgent conditions that were removed under the new provider arrangements.
Great Western Hospitals NHS Foundation Trust, took over responsibility for Moredon Medical Centre part way through the 2019/20 Quality and Outcomes Framework (QOF) reporting period. (QOF is a voluntary scheme within the General Medical Services (GMS) contract. It aims to support providers to deliver good quality care.) As a result, performance data from April to November 2019 related to the previous provider’s activities.
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 Requires Improvement overall and Requires Improvement for all population groups in the Effective key question, meaning this affects all population groups overall.
We rated the practice as Requires Improvement for providing safe services because:
- The practice was unable to demonstrate effective management of risks in relation to medicine safety alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).
- Some actions from the practice's Infection Prevention and Control audit had not been addressed.
We rated the practice as Requires Improvement for providing effective services because:
- Performance data was below local and national averages and this affected the outcomes for patients including those with some long-term conditions and patients experiencing poor mental health.
- The practice did not have processes in place to track hospital referrals.
- There was limited monitoring of the outcomes of care and treatment. No clinical audits were available to demonstrate quality improvements had been reviewed and actioned.
- A backlog of unreviewed hospital letters, and correspondence from other sources, meant information was not always accurate, valid, reliable and timely.
- Measures to address performance and health outcomes for patients were not yet fully embedded.
We rated the practice as Requires Improvement for providing responsive services because:
- Although services could be accessed in a more timely manner, and there was more continuity of care, the service needed to make further improvements.
We rated the practice as Requires Improvement for providing well-led services because:
- Improvements were needed regarding governance systems, accurate and reliable data, and the management of risks.
- Before taking over the contract, the new provider had undertaken due diligence assessments to understand the significance of the issues identified from the previous provider. The issues identified were more significant when the new provider began working within the practice.
- The provider recognised the significant improvement and transformation that Moredon Medical Centre required. However, some of the changes and improvements had not been implemented as the new provider had only commenced the management of the service 12 weeks preceding this inspection.
We rated the practice as Good for providing caring services because:
- Staff treated patients with kindness, respect and compassion.
- Staff helped patients be involved in decisions about their care and were aware of the Accessible Information Standard (a requirement to make sure that patients and their carers can access and understand the information they are given).
- The practice respected and promoted patients’ privacy and dignity.
We found areas where the provider must make improvements. The provider must:
- Ensure care and treatment is provided in a safe way to patients.
- 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).
We found areas where the provider should make improvements. The provider should:
- Continue to monitor and review processes for quality improvement activity. For example, undertaking clinical audits.
- Continue to embed formal assurance processes. Specifically, the formal minuting of safeguarding meetings, and monitoring of consent.
- Continue to ensure regular multi-disciplinary case review meetings for all patients on the palliative care register.
Following the inspection, we issued the provider with a Letter of Intent. The Letter of Intent offered the provider the opportunity to put forward documentary evidence which may provide assurance that the risks identified had already been removed, or mitigated through an action plan. We received an action plan, setting out how the provider had already addressed each of the concerns we identified, or how they intended to address outstanding actions. The action plan set out a specific time frame for implementing each action and who would be doing it, with documentary evidence supporting any actions taken or intended. This included procedures and processes the provider intended to put in place to ensure that risks concerning (for example) safety alerts, cancer referrals and blood tests would be mitigated. Based on the action plan, we were assured that the risks identified would be addressed.
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