Background to this inspection
Updated
26 August 2020
The registered provider is DMC Healthcare Limited which is a primary care at scale organisation delivering care over a number of registered locations in England.
St Mary’s Island Surgery is located at Edgeway, St Mary’s Island, Chatham, Kent, ME4 3EP and has branch surgeries;
- DMC Pentagon Surgery, Boots, 30-34 Military Road, Chatham, Kent, ME4 4BB.
- DMC Sunlight Surgery, Sunlight Centre, Gillingham, Kent, ME7 1LX.
- DMC Balmoral Gardens, Green Suite, Balmoral Gardens, Gillingham, Kent, ME7 4PN.
- DMC Twydall Green, Twydall Clinic, Gillingham, Kent, ME8 6JY.
The practice holds an alternative provider medical services contract with NHS England for delivering primary care services to the local community. The practice website is www.stmarysislandsurgery.co.uk.
As part of our inspection we visited St Mary’s Island Surgery, where the provider delivers registered activities. St Mary’s Island Surgery has a registered patient population of approximately 28,500 patients. There are arrangements with other providers (MedOCC) to deliver services to patients outside of the practice’s working hours.
St Mary’s Island Surgery is registered with the Care Quality Commission to deliver the following regulated activities: diagnostic and screening procedures; family planning; maternity and midwifery services; surgical procedures; treatment of disease, disorder or injury.
Updated
26 August 2020
We carried out an announced comprehensive inspection at St Mary’s Island Surgery on 9 July 2019. The overall rating for the practice was Requires Improvement. The full comprehensive report on the July 2019 inspection can be found by selecting the ‘all reports’ link for St Mary’s Island Surgery on our website at www.cqc.org.uk.
After our inspection in July 2019 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.
We carried out an announced comprehensive follow-up inspection on 14, 15, 17, 20 and 21 January 2020 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 9 July 2019. This report covers findings in relation to those requirements.
This practice is now rated as Inadequate overall.
The key questions at this inspection are rated as:
Are services safe? – Inadequate
Are services effective? – Inadequate
Are services caring? – Requires Improvement
Are services responsive? – Inadequate
Are services well-led? – Inadequate
We rated the practice as Inadequate for providing safe services because:
- The practice needed to make further improvements to systems, practices and processes to help keep people safe and safeguarded from abuse.
- The practice needed to make further improvements to the way risks to patients, staff and visitors were being assessed, monitored or managed.
- Although the practice had made some improvements, staff still did not always have the information they needed to deliver safe care and treatment.
- The practice needed to make further improvements to the arrangements for medicines management to help keep patients safe.
We rated the practice as Inadequate for providing effective services because:
- Care and treatment were still not always delivered in line with current legislation, standards and evidence-based guidance.
- The practice needed to make further improvements to their programme of quality improvement activity and how they routinely reviewed the effectiveness and appropriateness of the care provided.
- Child immunisation uptake rates were still lower than the target percentage of 90% or above in all four indicators.
- The practice’s performance in four out of five cancer indicators had deteriorated.
- All staff were still not up to date with all essential training.
- All staff were still not receiving regular appraisals.
- The practice did not always act on incoming correspondence from other organisations in a timely manner.
We rated the practice as requires improvement for providing caring services because:
- National GP patient survey results had improved since our last inspection in July 2019 and feedback we received from patients was predominantly positive about their experience of being involved in decisions about care and treatment. However, we also received negative feedback from patients about the care they received regarding: some staff being rude; delays with referrals to other providers for tests; investigations and treatment not being carried out in a timely manner; and difficulties in obtaining repeat prescriptions.
We rated the practice as inadequate for providing responsive services because:
- The practice organised services to meet patients’ needs. However, there were still not sufficient staff with which to deliver services to meet patients’ needs.
- Requests for home visits were still not always being triaged by a clinician in a timely manner.
- People were still not able to access care and treatment from the practice within an acceptable timescale for their needs.
We rated the practice as inadequate for providing well-led services because:
- Local clinical leadership was now limited, remained complex and still did not always function as intended by the provider.
- The processes and systems to support good governance and management were not always effective.
- The practice needed to make further improvements to their processes for managing risks and issues.
- The practice needed to make further improvement to adequately manage and improve some performance that fell below local and national averages.
- Completed clinical audit cycles that drove improvement were limited.
- The practice did not always act upon incoming appropriate and accurate information.
The areas where the provider must make improvements are:
- 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.
- Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.
- Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.
- Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
The areas where the provider should make improvements are:
- Stock the emergency antibiotic cefotaxime as soon as it becomes available again to order.
- Provide details of the Parliamentary and Health Service Ombudsman when replying to all complainants.
- Revise the system to help keep all governance documents up to date.
I am placing the service in special measures. Services placed in special measures will be inspected again in 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 reassurance that the care they get should improve.
Dr Rosie Benneyworth MB BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care
Please refer to the detailed report and the evidence tables for further information.