Leap Valley Medical Centre

We carried out this inspection following our annual review of the information available to us, which indicated that there may have been a significant change (either deterioration or improvement) to the quality of care provided since the last inspection. We also followed up on the breaches of regulation 17 HSCA (RA) Regulations 2014, identified at the previous inspection 15 and 16 November 2018. This inspection looked at the following key questions:

Are services Safe?

Are services Effective?

Are services Caring?

Are services Responsive?

Are services Well-led?

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.

At the last inspection in November 2018 we rated the practice as good overall and requires improvement for providing well-led services because: the provider had failed to establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care, in breach of Regulation 17 HSCA (RA) Regulations 2014 and a requirement notice was issued.

At this inspection, we found the provider had taken appropriate action to address the requirement notices from the last inspection.

We have rated this practice as requires improvement overall, with a rating of requires improvement for safe, effective, caring, well-led and inadequate for responsive.

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

• Patient Specific Directions were not managed in line with legal requirements.
• Some items of emergency equipment and medicines held were out of date and had not been replaced.
• There was a backlog in summarising patient records back to November 2018.

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

• Exception rate reporting for some population groups was higher than local and national averages e.g. long-term conditions, including diabetes and COPD.
• The Public Health England target for cervical screening uptake, within the working age people population group had not been met.

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

• Staff did not always treat patients with kindness, respect and compassion.
• Patients expressed concerns about the way some of the reception staff dealt with them whilst trying to access services or book appointments.
• Performance indicators from the national GP survey relating to care and treatment as well as the overall patient experience of the GP practice was below local and national averages.

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

• Patient satisfaction was below average for access to services particularly via the telephone.
• The practice had undertaken actions to make improvements to the telephone system which incurred delays that were out of the control of the practice. The practice continued to work with stakeholders to address issues and continue to make improvements, however, there was limited evidence to demonstrate whether proposed changes had improved patient satisfaction.

The inadequate areas found during inspection impacted on all population groups within the responsive domain, we have therefore rated all population groups as inadequate overall.

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

• The practice had restructured the leadership and management team so that leaders had time to focus on service development and patient needs. They understood the challenges facing them and had improvement plans in place to address them, however the leadership and governance arrangements in place were not fully embedded across all locations. This led to safety concerns and inconsistences in record keeping and systems.

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 monitor and improve the uptake of cervical screening for disease prevention.
• Continue to monitor and improve areas of high exception reporting.

This practice is rated as Good overall. (Previous rating May 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Leap Valley Medical Centre and the branch surgery at Abbotswood on 15 and 16 November 2018 as part of our inspection programme.

At this inspection we found:

• There had been a significant change in the leadership at the practice since April 2017. The practice had recognised that sustainability and succession planning were needed to ensure the continued safe running of the practice. To facilitate this, they had recently merged with a local practice so that running costs, some administrative work and clinical teams could be used across the patch and ensure the continued level of service provision. This had involved a complete restructuring process which was on-going at the time of the inspection.
• We found that the ‘merging’ practice with an APMS contract which did not allow for a shared patient list, meant the two services were working with two EMIS patient record systems, and running parallel rather than as one service. This had an impact on the service as there was still duplication of work and the benefits of being one joined up service was limited.
• Practice leaders had established policies, procedures and activities to ensure safety but did not have systems in place to monitor and assure themselves that they were operating as intended. For example, learning from complaints was localised and not widely shared.
• Staff treated patients with compassion, kindness, dignity and respect.
• Patients feedback through the national GP patient survey (2018) indicated that although the appointment system was easy to use they experienced delays in being able to access routine care when they needed it.
• The provider had been responsive to the national GP patient survey (2017) and had introduced an urgent care team so that any patient contacting the practice for an urgent appointment had a telephone consultation with a clinician who then directed them to the most appropriate care.
• There was a focus on continuous learning and improvement within the organisation.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Risk assess the emergency medicines which were not held by the practice.

• Update training for reception and administrative staff in respect of sepsis and provision of accessible information.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.