The Care Quality Commission
  • Doctor
  • GP practice

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

Overall: Inadequate read more about inspection ratings

Pepperall Road, Highbridge, Somerset, TA9 3YA (01278) 783220

Provided and run by:
Dr M J Bizon & Partners

Important: The provider of this service changed. See new profile

All Inspections

2 August 2016

During a routine inspection

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

29 September 2015

During a routine inspection

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 29 September 2015. Overall the practice is rated as inadequate.

We found the practice inadequate for providing responsive and well-led services. The practice requires improvement for safe, effective and 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:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews and investigations were not thorough enough. Patients did not always receive a verbal and written apology when things went wrong or they had a poor experience ofare or treatment.

  • Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks and medical devices.

  • Although some audits had been carried out, we saw no evidence that audits were driving quality improvement in performance to improve patient outcomes.
  • The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.
  • Urgent telephone appointments were usually available on the day they were requested. However some patients told us that telephone access to the practice was difficult and that they sometimes had to wait a long time for non-urgent appointments.
  • There was a clear leadership structure and staff felt supported by management. However there was not a clear vision to deliver high quality care and promote good outcomes for patients. The approach to service delivery and improvement was reactive and focused on short term issues.
  • The practice had a number of policies and procedures to govern activity.
  • The practice had an active patient participation group (PPG).
  • The practice was unclear how feedback from the Friends and Family Test and national GP patient survey was used to improve services for patients.
  • There was a lack of leadership capacity within the practice to make the required changes to improve patient outcomes and experience.

The areas where the provider should make improvements:

  • The practice should update their knowledge and strengthen governance arrangements on the safe storage and use of controlled medicines in practice to minimise their risks and harms.

  • Review the disaster recovery plan to include included emergency contact numbers for staff and main utility services contact details.

  • Improve the availability of non-urgent appointments during core practice hours and review patient feedback around the difficulty of accessing the practice through the telephone system.

The areas where the provider must make improvements:

  • The practice must make sure that the management of medicines and prescription security follow guidelines and are safe at all times.

  • Review the process and procedures for patient complaints and significant events and ensure that patients affected receive reasonable support and a verbal and written apology.

  • Review the recruitment policy /procedures and arrangements to include all necessary employment checks for all staff.

  • Improve the system for checking of and calibration of medical equipment.

  • Ensure there are adequate systems to assess, monitor and improve the quality improvement activity used to inform patient care. These must be aligned to national benchmarking.

  • Operate effectively to assess, monitor and improve the quality and safety of the services

  • Ensure adequate fire safety training for staff is in place so that fire prevention and emergency action plans can be put into practice. This must include a system in place to check emergency lighting.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration or vary the terms of their registration with the CQC.

Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

3 October 2013

During a routine inspection

We spent the day visiting Highbridge Medical Centre where we met and talked with patients, two GPs, the practice manager, two practice nurses and administration staff. We also met with the chairperson and a member of the local Patient Participation Group who told us about the work of the local group representing patients' views.

All the patients we met with made positive comments about the treatment they received. We were told by patients who were at the surgery when we visited "I think the care is excellent" and "I've had nothing but the very best care and attention."

We found the practice respected the dignity, privacy and independence of people they looked after. People were able to make decisions about their treatment. They were treated with consideration and respect. People were encouraged to express their views and given opportunities to be involved in how the practice was run.

The clinical staff demonstrated how people were referred safely into the care of other health and social care professionals. We found that staff were trained and supported to carry out their roles and responsibilities. The provider monitored the services provided to ensure they were safe and effective.