The Care Quality Commission
  • Doctor
  • GP practice

Archived: The Boulevard Medical Centre

Overall: Inadequate read more about inspection ratings

635 Western Boulevard, Nottingham, Nottinghamshire, NG8 5GS (0115) 978 6557

Provided and run by:
JRB Healthcare

All Inspections

27 Jun 2019

During an inspection looking at part of the service

We carried out an unannounced focussed inspection at Boulevard Medical Centre on 27 June 2019 in response to concerns that we found at another practice which was part of the Beechdale Medical Group.

The practice had previously been inspected in June 2018 where it was rates as good overall.

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:

  • The practice did not have clear systems and processes to assess, monitor and manage risks to patients safety.
  • There was no clinical oversight of staff working at the practice.
  • The premises were not fit for purpose and there was not effective infection prevention and control measures.
  • Equipment and medicines were out of date and put patient’s safety at risk.
  • There was limited monitoring of patient safety.
  • Care and treatment were not always delivered in line with national guidance.
  • The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.

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

  • The practice was transitioning through a change in management and systems had not been embedded.
  • Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
  • 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.

As a result of these concerns, we took immediate action to impose urgent conditions remove the location on the registration. This means that regulated activities can no longer be carried out at The Boulevard Medical Centre.

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

22 February 2018 and 7 March 2018

During a routine inspection

We carried out an announced comprehensive inspection at The Boulevard Medical Centre in May 2017. The overall rating for the practice was requires improvement.

The full reports from the previous inspections can be found by selecting the ‘all reports’ link for The Boulevard Medical Centre on our website at www.cqc.org.uk.

This inspection was a comprehensive inspection with a site visit undertaken on 22 February 2018. The Boulevard Medical Centre is one of four locations of the provider ‘The Beechdale Medical Group’, All four locations were inspected between 22 February 2018 and 7 March 2018. The overall rating for this location is good.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

Our key findings were as follows:

  • The practice had implemented clear systems to manage risk so that safety incidents were less likely to happen. Where incidents occurred, the practice used these are opportunities for learning and reviewed their processes. Effective recording systems had been introduced to ensure significant events and incidents were monitored and reviewed.
  • Arrangements to respond to emergencies had been significantly improved; arrangements had been standardised across the practice group.
  • Regular risk assessments were undertaken including risk assessments in respect of fire and health and safety issues.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff were supported to access the training required to fulfil their roles and received regular appraisals. Arrangements for the support and supervision of nursing staff had been strengthened.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
  • Leadership arrangements had been reviewed and improved across the practice group; this included the recruitment of a new business manager to provide strategic and operational leadership.

However, there were also areas of practice where the provider should make improvements.

The provider should:

  • Continue to improve the use of the clinical system to ensure all tasks are managed appropriately

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

11 and 23 May 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Location name on 11 and 23 May 2017. Overall the practice is rated as requires improvement.

The Boulevard Medical Centre is a registered location under the provider, The Beechdale Medical Group. All of the providers four registered location were inspected on 11 and 23 May 2017; all four locations have been rated inadequate for the well-led domain.

Our key findings across all the areas we inspected at Boulevard Medical Centre were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews, investigations and learning from significant events was not documented clearly enough. It was not evident that learning was shared widely enough in the practice.
  • Some risks to patients were assessed and managed. However, the practice had not considered and identified all risks. For example, those relating to recruitment checks and legionella.
  • Data showed patient outcomes were in line with or above local and national averages.
  • The majority of patients said they were treated with compassion, dignity and respect.
  • Information about services was available but not in a variety of formats, so not everybody would be able to understand or access it.
  • The practice had a number of policies and procedures to govern activity and staff knew how to access these.

The areas where the provider must make improvements are:

  • Ensure recruitment arrangements include all necessary employment checks for all staff.
  • Ensure policies are implemented and systems are operated effectively to assess, monitor and mitigate risk.
  • Ensure that staff complete all relevant training, including refresher training, so that their skills are knowledge are up to date.

In addition the provider should:

  • Have arrangements in place to assure the safe and proper management of medicines in line with recognised guidance and best practice.
  • Facilitate annual health checks for all patients with a learning disability.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice