Archived: Springfield Medical Centre

This practice is rated as Good overall. The service was first inspected in November 2015 and rated good overall. It was inspected again in February 2018 and rated inadequate overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Springfield Medical Centre on 20 August 2018. The inspection was carried out to follow up on breaches of regulations identified during our previous inspection in February 2018. Patients were potentially at risk of harm because systems were not operated effectively manage risks. There were some processes in place for disseminating NICE guidance but there was no evidence of discussion of NICE guidance within the practice. Data from the Quality and Outcomes Framework showed patient outcomes were below local and average such as those for diabetes. There were limited mechanisms in place to review performance and quality of the care delivered to patients.

At this inspection we found:

• The practice had made significant improvements since our previous inspection to improve the service.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice had made improvements to its risk management process to keep patients safe, including those for dealing with high risk medicines and patient safety alerts.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment were delivered according to evidence-based guidelines. Minutes of clinical meetings we looked at showed National Institute for Health and Excellence (NICE) guidance was shared and discussed.
• The practice monitored achievement for the Quality and Outcomes Framework (QOF) and had made improvements where identified. Most recent data supplied by the practice showed that QOF achievement was in line with local and national averages.
• Staff involved and treated patients with compassion, kindness, dignity and respect. The practice had worked to improve in areas identified in the national GP patient survey for satisfaction scores for consultations with GPs.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Governance processes were strengthened and we saw action plans in place to review performance and improve quality of the care delivered to patients.
• There was evidence of continuous learning and improvement.

The areas where the provider should make improvements are:

• Encourage patients to join the Patient Participation Group (PPG) in the practice to reflect a range of patient population groups.
• Continue to identify ways in which the uptake of childhood immunisation for under five-year olds could be further improved
• Continue to identify ways to improve cancer screening, particularly for breast screening.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

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.

We carried out an announced comprehensive inspection at Springfield Medical Centre on 14 November 2017. The overall rating for the practice was inadequate and it was placed into special measures. The full comprehensive report on the November 2017 inspection can be found by selecting the ‘all reports’ link for Springfield Medical Centre on our website at www.cqc.org.uk.

The overall rating of inadequate will remain unchanged until we undertake a full comprehensive inspection of the practice within the six months of the publication date of the report from February 2018.

This inspection was an announced focused inspection carried out on 6 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations set out in the warning notices issued to the provider.

The warning notices were issued in respect of regulations related to safe care and treatment and good governance. Specifically, the service provider had not done all that was reasonably practicable to mitigate risks to the health and safety of service users receiving care and treatment. This included risks related to arrangements for dealing with emergencies; fire risk; legionella risk; the monitoring of patients being prescribed high risk medicines and the arrangements for the security of prescriptions. The provider had also not ensured that governance arrangements were operated effectively to assess, monitor and improve the quality of services; to assess, monitor and mitigate risks relating to the service and to evaluate and improve the service.

Our key findings were as follows:

• The practice had complied with the warning notices that we issued and had taken action to ensure they met with legal requirements.

• There was a performance improvement plan which was regularly reviewed at clinical and staff meetings.

• There was an improved meeting structure and meeting minutes were easily available to staff.

• The process in place to review and act on safety alerts and Medicines and Healthcare products Regulatory Authority (MRHA) alerts had improved significantly. The policy had been revised and a comprehensive log was maintained to summarise the receipt of incoming alerts, their dissemination and the follow up actions taken.

• A comprehensive fire risk assessment had been carried out by an external company, and recommended improvements made to improve safety. Monthly checks were carried out by practice staff.

• Remedial action had been taken to address medium and low level risks identified in a legionella assessment carried out in February 2015. (high level risks had previously been addressed)

• The process for monitoring patients taking high risk medicines had been strengthened.

• The process for checking the suitability of emergency equipment, including expiry dates of medicines used in an emergency had been strengthened.

• The management of prescription stationary had been improved and locks had been applied to cupboards and printer trays where stationary was stored.

• There was an improved process to monitor and manage uncollected prescriptions.

• Security had improved with regards to storage and access to patient records.

• Action had been taken to rectify a coding error that had resulted in poor QoF achievement for patients diagnosed with depression. Relevant patients now had the correct clinical code applied and were regularly reviewed.

• Improvements had been made to the management of patients diagnosed with diabetes. Data showed that QoF achievement for diabetes related indicators had improved and likely to be in line with CCG averages.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice