Archived: Dr M J Bizon & Partners Also known as Highbridge Medical Centre

Updated 3 November 2016

Dr M J Bizon & Partners (Highbridge Medical Centre) is located in Highbridge, situated seven miles north of Bridgwater, on the edge of the Somerset Levels in the Sedgemoor district of the county of Somerset. The practice provides primary medical services to approximately 13,100 patients living in Highbridge and the surrounding area. This includes six care homes, three homes for patients with a learning disability and emergency housing for young people and up to 19 families.

The practice was previously inspected by the CQC on 29 September 2015 and as a result was placed into special measures. During that inspection we found the practice inadequate for providing responsive and well-led services. The practice required improvement for safe, effective and caring services. We told the provider to take action against areas of concern.

Data from Public Health England show that the practice had a higher than average population of patients over 65, 25%, in comparison with the clinical commissioning group (CCG) average of 23% and a national average of 17%. The population of Highbridge as a whole is older than the national average. The practice is situated in an area with less deprivation with a deprivation score of 22% compared to the CCG average of 18% and the national average of 22%.

The practice is located in a purpose built surgery built in 1993. The practice has a spacious waiting area with the ground floor and the consulting rooms accessible to patients. The first floor provides administrative rooms. Within the building is an independent pharmacy.

The practice team includes four GP partners (three male and one female) and one salaried GP (female). A locum GP provides two sessions per week. Currently the practice provides 36 GP sessions per week. A specialist diabetes practice nurse is employed and a locum respiratory nurse provides one session per week. A primary care practitioner (paramedic) has recently started and is undertaking induction with the aim of providing 10 sessions per week providing care and treatment within the practice and in patients’ homes. In addition there are three practice nurses; one health care assistant; a practice manager; reception and administrative staff. One GP partner was on a sabbatical during our previous inspection and they have now left the practice. A key concern for the practice is the difficulty recruiting GPs with three whole time equivalent GP vacancies. In addition an experienced nurse practitioner and a health care assistant had recently left the practice with three more clinical staff due to leave. At the time of our inspection the practice manager was on long term leave. A temporary practice manager was in place on the day of our inspection.

The locality health visitors and midwives service is based within the practice. An osteopath and a physiotherapist provided private appointments within the practice premises.

The practice is a training practice for student nurses and GP trainees. At the time of our inspection one GP trainee was being supported by the practice.

The practice has a Primary Medical Services contract (PMS) with NHS England to deliver general medical services. The practice provides enhanced services which included extended hours for appointments; facilitating timely diagnosis and support for patients diagnosed with dementia and minor surgery.

The practice is open from 8.30am to 6.30pm with lunchtime opening recently being introduced. Extended hours surgeries are available from 7.30am to 8am and 6.30pm to 7.30pm however the practice does not offer these on set days and are based on GP availability. Since our previous inspection alternate Saturday morning appointments are no longer available. In addition the practice closes at 12.30pm one Tuesday per month for training. During this time patient care is provided by another practice under a reciprocal agreement.

In addition the practice provides cover to Burnham-on-Sea Community Hospital. This is a 22-bedded unit with clinical care managed by Highbridge Medical Centre and another local GP practice during normal working hours on a two week on, two week off rota.

The practice has opted out of providing Out Of Hours services to their own patients. Patients can access a local provider which provides an NHS111 and an Out Of Hours GP service.

Updated 3 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr M J Bizon & Partners (Highbridge Medical Centre) on 2 August 2016 to check if improvements have been made in response to the practice being placed in special measures, with an overall rating of inadequate. Overall the practice remains rated as inadequate.

We found the practice inadequate for providing safe, effective, responsive and well-led services. The practice requires improvement for caring services. We also found the services for the population groups inadequate to align with these ratings.

Our key findings across all the areas we inspected were as follows:

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment to ensure that appropriate staff were employed.

• Staff were not following policies; procedures; guidance and current legislation for the safe storage of blank prescription papers to prevent theft or fraud.

• Risks in regard of patients and staff were ineffectively managed in areas such as; medicines management; training and development; infection control; staffing levels, access to appointments and governance arrangements.

• There was limited evidence of an overarching view or summary of significant events and information of completion of suggested actions.

• The outcomes for patients as a result of consultation, care and treatment were hard to identify as the practice governance systems made little or no reference to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally .

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

• Access and appointment systems were not working well, resulting in patients not receiving timely care when they needed it.

• The practice were unable to evidence formal governance arrangements.

The areas where the provider must make improvements are:

• Ensure infection prevention and control systems take account of identified risk assessment actions;

• Ensure recruitment arrangements and ongoing monitoring of staff include all necessary employment checks.

• Ensure adequate staffing levels are in place to provide timely access to the practice through the telephone system, adequate urgent and non-urgent appointments during core practice hours and timely referrals to other services for advice and treatment;

• Ensure safe systems and processes are in place to clarify the urgency of the need of patients for medical attention so they are provided with care and treatment, by the most appropriate person, in a timely manner.

• Ensure patient complaints are listen to, acted upon and responded to, to provide effective outcomes for patients.

• Introduce quality improvement initiaitves to ensure improvements in clinical care and other processes have been achieved.

• Ensure there are management support systems and records in place for staff training and ongoing staff support including appropriate supervision and appraisal.

• Ensure governance arrangements assess and monitor risks to improve the quality of the service provision.

The areas where the provider should make improvement are:

• Review the system for the significant event process. This should include evidence of completed action plans and lessons learnt.

• Provide evidence of safety checks for equipment such as boilers, electrical wiring and non-medical equipment.

• Improve the recording of patient monitoring when individual patient care and treatment plans differ from normal or recognised practice.

• Review actions taken in response to the outcomes of any patient feedback such as the Friends and Family Test and national GP patient survey with regards to improving services for patients.

• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.

This service was placed in special measures in February 2016 in order for the provider to take steps to improve the quality of the services it provided. We found insufficient improvements have been made such that there remains a rating of inadequate for responsive and well-led. In addition safe and effective have now been rated as inadequate. Caring remains as requires improvement.

Therefore we are taking 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 vary the conditions of their registration within six months if they do not improve. The service will be kept under review and if needed measures could be escalated to urgent enforcement action.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 November 2016

The practice is rated as inadequate for patients with long-term conditions. The provider was rated as inadequate for safe, effective, responsive and well-led and requires improvement for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group. During our inspection we had difficulties verifying supporting evidence was in place for patients with long-term conditions. Not all the information we requested prior to our inspection was made available.

• Practice nurses provided home visits to ensure housebound patients received the same quality of care as patients attending the practice for management of long-term conditions.
• Practice nurses had lead roles in chronic disease management.

Updated 3 November 2016

The practice is rated as inadequate for the care of families, children and young people. The provider was rated as inadequate for safe, effective, responsive and well-led and requires improvement for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group. During our inspection we had difficulties verifying supporting evidence was in place for the care of families, children and young people. Not all the information we requested prior to our inspection was made available.

• We saw good examples of joint working with health visitors when following up children living in disadvantaged circumstances or who were at risk of harm or abuse.
• Some patients told us they always received on the day appointments for children. However Care Quality Commission comment cards stated patients had received inappropriate referrals to other services when they requested an urgent GP appointment.

Updated 3 November 2016

The practice is rated as inadequate for the care of older people. The provider was rated as inadequate for safe, effective, responsive and well-led and requires improvement for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group. During our inspection we had difficulties verifying supporting evidence was in place for the care of older people. Not all the information we requested prior to our inspection was made available.

• The practice offered home visits for those with enhanced needs.
• The practice provided patients with a foot care clinic.

Updated 3 November 2016

The practice is rated as inadequate for working age patients. The provider was rated as inadequate for safe, effective, responsive and well-led and requires improvement for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group. During our inspection we had difficulties verifying supporting evidence was in place for working age patients. Not all the information we requested prior to our inspection was made available.

• Although the practice offered extended opening hours for appointments patients reported difficulties accessing the practice and appointments. Extended opening was dependent on weekly availability of GPs.
• Online access was available for ordering repeat prescriptions.

Updated 3 November 2016

The practice is rated as inadequate for patients experiencing poor mental health. The provider was rated as inadequate for safe, effective, responsive and well-led and requires improvement for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group. During our inspection we had difficulties verifying supporting evidence was in place patients experiencing poor mental health. Not all the information we requested prior to our inspection was made available.

• The practice worked with a social enterprise to provide specialist services for patients affected by substance misuse within the practice in the case management of patients experiencing poor mental health.
• We saw physical health checks for patients experiencing poor mental health had improved since our previous inspection.

Updated 3 November 2016

The practice is rated as inadequate for patients whose circumstances may make them vulnerable. The provider was rated as inadequate for safe, effective, responsive and well-led and requires improvement for caring. The concerns which led to these ratings apply to everyone using the practice, including this population group. During our inspection we had difficulties verifying supporting evidence was in place patients whose circumstances may make them vulnerable. Not all the information we requested prior to our inspection was made available.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• The practice carer’s champion had ceased employment and had not been replaced. There was not a designated person to identify and prioritise the needs of carers and offer them appropriate advice and support.