Severn Fields Medical Practice Also known as Haughmond View Medical Practice

We carried out an announced focused inspection at Severn Fields Medical Practice on 17 July 2019. We decided to undertake an inspection of this service following our annual review of the information available to us. This process identified a possible decline in the quality of care provided. This inspection looked at the following key questions: safe, effective responsive and well-led. Information available to us did not indicate that the quality of care had changed in relation to the key question caring. As a result, the rating for caring has been carried forward to contribute to the overall rating for this practice.

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 previously carried out a focused inspection at Severn Fields Medical Practice on 16 February 2017. The inspection was undertaken to review a previous breach of legal requirement in relation to safe care and treatment that was identified at the comprehensive inspection undertaken on 31 May 2016. We found the provider had addressed the concerns identified. The reports on these inspections can be found by selecting the ‘all reports’ link for Severn Fields Medical Practice on our website at .

We have rated this practice as requires improvement overall.

The practice is rated as inadequate for providing safe services because:

• The management of safety systems and processes to keep people safe and safeguarded from abuse was not effective. This was particularly in relation to safeguarding, staff training and ensuring information received from secondary care concerning children who presented with injury and or had not attended their appointment were followed up. Not all staff were aware of the practice safeguarding leads.
• The practice did not have effective systems in place for some processes relating to the safe management of medicines and reviews. Risks associated with emergency situations and events had not been fully identified, assessed and managed. A risk assessment had not been carried out to the explain the rationale for not stocking the suggested medicines in the event of a medical emergency. In addition, the system for checking emergency medicines held within the practice and their location required review to ensure medicines were readily accessible by staff.
• Records reviewed showed a significant number of patients on repeat prescriptions were overdue a medicines review. Most patients prescribed high risk medicines had been reviewed and assessed.
• An effective system was not in place for the review of pathology test results.
• Medicines prescribed in secondary care were not consistently documented on patients records.
• The process for ensuring all patient safety alerts issued were received and actioned was not always effective.
• At the time of the inspection there was no documented evidence available that the practice had assured themselves that the required health and safety checks and risk assessments had been completed by the landlord.
• Not all staff had received or were up to date with training in safe working practices.
• Only one of the three designated fire wardens had received fire marshal training to support them in their role.
• The practice had carried out their own infection prevention and control audit, which identified actions. However, an action plan had not been developed to identify the specific action to be taken, by whom and the date of completion.
• A complaint had not been considered or investigated as a significant event to improve the quality of patient care from the lessons learnt.
• There were not enough clinical staff employed to meet patient demand.

We rated the practice as requires improvement for providing effective services because:

• A significant number of patients were overdue a structured medicines review.
• Not all staff had received an appraisal of their work.
• Not all staff had received up to date training.

These areas affected all population groups so we rated all population groups as requires improvement.

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

• Many patients were unable to book either same day or pre-bookable appointments when they needed them.
• Some patients found it difficult to get through to the practice on the telephone.
• A complaint had not been investigated through the formal complaint’s procedure or considered a significant event to improve the quality of patient care from the lessons learnt.
• The unverified results for the 2019 national GP survey for the practice showed a decrease in patient satisfaction in relation to getting through to someone at the practice on the phone; the overall experience of making an appointment and satisfaction with the GP practice appointment times. The practice results for all but two of the questions asked were below the local and national averages.

We rated the practice requires improvement for providing a well-led service because:

• The practice did not have sufficient systems to identify, manage and mitigate risk.
• There were gaps in the practice’s governance systems and processes and the overall governance arrangements were not effective.
• There were no formal arrangements to assess staff with extended roles who worked autonomously making clinical assessments for patients who presented with undifferentiated clinical conditions.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a consistent safe way to patients
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure that persons employed in the provision of the regulated activity receive the appropriate training and appraisal necessary to enable them to carry out the duties.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Continue to review staffing levels.
• Improve patient experiences of accessing the service.
• Develop an action plan in response to the National GP Patient Survey 2019.
• Improve signage around the practice.

Within 48 hours of the inspection the provider sent us an action plan in response to the immediate concerns that we identified on the day of the inspection

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of General Practice