The Sunflower Medical Centre

We carried out an announced comprehensive inspection at Manor House Medical Centre on 23 January 2020 as part of our inspection programme.

We decided to undertake an inspection of this service following our annual review of the information available to us. This was a comprehensive inspection that looked at all the key questions.

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 keep patients safe.
• Staff vaccination was not maintained in line with current Public Health England (PHE) guidance.
• Appropriate standards of cleanliness and hygiene were not met.
• There were gaps in systems to assess, monitor and manage risks to patient safety.
• The practice did not always have the information they needed to deliver safe care and treatment.
• The practice did not have appropriate systems in place for the safe management of medicines.
• The practice did not learn and make improvements when things went wrong.

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

• Some performance data was significantly below local and national averages.
• There were no systems in place to keep clinicians up to date with current evidence-based guidance.
• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.
• The practice was unable to show that it always obtained consent to care and treatment.

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

• Feedback from patients was mostly negative about the way staff treated people and there was no evidence provided to show how the practice had acted to improve patient satisfaction with the service.
• There was feedback from patients regarding access to the service was lower than average.
• Complaints were not always used to improve the quality of care.

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

• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
• While the practice had a clear vision, that vision was not supported by a credible strategy.
• 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.

These areas affected all population groups so we rated all population groups as inadequate overall.

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:

• Take action to review the availability of practice information in easy read format.
• Monitor and improve patient access to the service.

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