Archived: New Parkfields Surgery

This practice is rated as ‘Requires Improvement’ overall.

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? - Requires improvement

We carried out an announced comprehensive inspection at New Parkfields Surgery (also known as Parkfields Surgery) on 22 August 2018. This inspection was undertaken following Hollybrook Medical Centre’s partnership registration, as the new provider for regulated activities at this location, with the Care Quality Commission (CQC) on 14 September 2017. The inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The new provider, Hollybrook Medical Centre, had been selected to take over the management of the New Parkfields Surgery by the Southern Derbyshire Clinical Commissioning Group (CCG) with effect from April 2017 (their registration with the CQC was effective from September 2017). The CCG initially awarded the contract for a period of 12 months, which was later extended to 18 months. The provider had since been successfully awarded a five-year contract, with effect from June 2018.
• The new provider informed us they had inherited a significant number of problems which needed to be resolved. We were informed how the issues had been addressed that were identified at CQC inspections under the previous registered partnership. In addition, further challenges were discovered by the new contractor leading to a comprehensive change programme for the practice, which had been ongoing for almost 18 months when our inspection took place.
• The new provider was part of a wider organisation and were in the process of updating their CQC registration at the time of our inspection. This organisation provided a corporate management structure which included the benefits of working at scale.
• There was improved continuity of care with GPs now providing regular clinical sessions on site, and patients told us they saw improvements. A female GP had been introduced to the team allowing choice for patients in consultations, and to promote choice when accessing services such as family planning.
• Skill mix arrangements were being developed with advanced nurse practitioner/nurse practitioner roles, although these only amounted to a few hours on site each week. A part-time pharmacist provided support on medicines management issues, and reviews of patients’ prescribed medicines. Joined up working with Hollybrook Medical Centre meant there was greater flexibility and capacity for GP clinical sessions, and staff such as a nurse with a specialism in diabetes management, offered more extensive care options to patients.
• Due to issues of multiple medicines being previously prescribed to patients, the provider had completed almost 2,000 medicines reviews since taking over the contract. This impacted significantly in reducing prescribing costs and ensured patients were only in receipt of the medicines they required to ensure they had appropriate and safe care.
• The provider had an achievement of 95% in the 2017-18 Quality and Outcomes Framework (QOF). These figures remained subject to external verification. We saw that the new provider had made good progress in tackling an inherited high level of exception reporting.
• Systems for safeguarding had improved significantly under the new provider. There was an identified lead for safeguarding on site and within the organisation. However, not all GPs were able to demonstrate they had completed up to date level 3 safeguarding training.
• The practice had systems to manage risk so that safety incidents were less likely to happen. However, we found that some incidents were not being reviewed effectively and opportunities for learning were not always identified.
• Environmental risk assessments had been undertaken, including fire and Legionella (Legionella is a term for a particular bacterium which can contaminate water systems in buildings). However, action plans were not being updated to evidence that issues had been effectively addressed. On site monitoring records (for example, water temperatures) was not always followed up when an issue had been identified.
• The practice ensured that care and treatment was delivered according to evidence-based guidelines.
• The results from the national GP patient survey were mostly below local and national averages. However, the practice was undertaking their own internal surveys and we saw that some improvement was being achieved. The majority of feedback we received from patient comment cards was positive, and some commented on the improvements that were being made in the last 18 months. On the day of the inspection, we saw staff treat patients with kindness, dignity and respect.
• Appointment systems had been reviewed and we observed that this was facilitating improved access to care when it was needed. The procurement of a new and improved telephone system, and an IT based interactive system was nearing completion. It was hoped these measures would impact positively on patient experience. Patients could access extended hours via a local hub service as part of the GP federation.
• The practice encouraged learning and improvement, and we saw that most staff were up to date with the practice’s training schedule. However, records for clinical staff training were not easily accessible.

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

• Ensure care and treatment is provided in a safe way to patients in accordance with the fundamental standards of care. For details, please refer to the requirement notice at the end of this report.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. For details, please refer to the requirement notice at the end of this report.

The areas where the provider should make improvements are:

• The provider should continue to work towards improving patient experience.
• The practice should review and improve quality improvement programmes in the practice.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

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