The Mandeville Practice - Care Quality Commission

Background to this inspection

Updated 14 March 2018

The Mandeville Practice is managed by Practice U Surgeries Limited who are an organisation commissioned to deliver a range of services nationally. They took over the contract of The Mandeville Practice in April 2016 when the previous GP partnership dissolved. The practice is part of the Aylesbury Vale Clinical Commissioning Group (CCG).

According to data from the office for national statistics, the practice population has a relatively low ethnic mix with approximately 22% from black and minority ethnic backgrounds. The practice boundary serves a larger than average working age population with fewer older patients. The average life expectancy for males and females is in line with national averages. There is a medium level of deprivation in the area with pockets of high deprivation locally.

The practice provides regulated activity from:

The Mandeville Practice, Hannon Road, Aylesbury, Buckinghamshire, HP21 8TR

The practice offers online services from its website: www.mandevillesurgery.co.uk

The practice did not have a registered manager; this was highlighted at the previous inspections in April 2017 and August 2017. Despite requesting submission of an application, at the time of this inspection in January 2018, CQC had not received any documentation or correspondence to commence the registration process.

The Health and Social Care Act 2008 states that registered providers must have a registered manager, set out in the regulations. The intention of this regulation is to ensure that people who use services have their needs met because the regulated activity is managed by an appropriate person. Following our inspections we were not assured the current arrangements ensured patients at The Mandeville Practice had their needs met or these arrangements met the requirements of the Health and Social Care Act 2008.

The practice had been inspected in April 2017 when it was found to be inadequate overall and was placed in special measures. We followed up on a warning notice in August 2017 when we found the practice remained in breach of the regulations.

The provider contract with the CCG is due to terminate on 31 March 2018 with a new provider taking over the contract on 1 April 2018.

Overall inspection

Inadequate

Updated 14 March 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Inadequate overall.

We carried out a comprehensive inspection of The Mandeville Practice in April 2017, the practice had an overall rating of Inadequate. Specifically, the practice was rated as requires improvement for safe, caring and responsive services and inadequate for effective and well led services. We undertook a focused inspection in August 2017 to follow up on warning notices that had been issued following the April 2017 inspection.

Following the January 2018 inspection the key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Inadequate

Are services well-led? - Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) – Inadequate

We carried out an announced comprehensive inspection at The Mandeville Practice on 10 January 2018. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether The Mandeville Practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

The practice did not have clear systems to identify and manage risk. For example, known high risk actions from a fire risk assessment had not been acted upon and other risk assessments had not been considered or documented. In addition, staff recruitment processes had not considered the risks associated with staff commencing employment before their background checks had been received.
There were duplicate safeguarding policies available, which may be confusing to staff and we found gaps in staff safeguarding training.
Patient outcomes data collected via the quality and outcomes framework demonstrated improvements in care for some patient groups although many remained below local and national averages.
The practice had not considered or responded to the needs of its elderly patients in a local care home.
Staff treated patients with dignity and respect.
The practice had recently changed the telephone system and all calls were now handled at the practice. It was too soon to gauge the impact this had on patients.
Governance processes and systems were not effective and had failed to identify a lack of staff training, risk assessments and patient care relating to dementia.

The areas where the provider must make improvements as they are in breach of regulations are:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.

The areas where the provider should make improvements are:

Review complaints response documentation to include details of the health ombudsman as in line with your provider policy.

This service was placed in special measures in June 2017. Although this report identifies where improvements and changes to practice have been made, insufficient improvements have been made overall. The practice is rated as inadequate for providing safe, effective, responsive and well-led services and good for caring services. As a result, I am keeping the practice in special measures and we have taken action in line with our enforcement procedures. At the time of this inspection we were aware of a planned change in provider contract in April 2018. 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 six months.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice