Meanwhile Garden Medical Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Meanwhile Garden Medical Centre on 7 July 2015. Overall the practice is rated as inadequate.

Specifically we found the practice inadequate for providing safe, effective, responsive and well-led services and requires improvement for providing caring services. It was also inadequate for providing services for older people, people with long term conditions, families, children and young people and requires improvement for working age people (including those recently retired and students) and people whose circumstances may make them vulnerable, and good for people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

• Patients were at risk of harm because inadequate systems were in place to keep patients safe including those for incident reporting, safeguarding, recruitment, infection control and medicine management.
• Systems were not in place to monitor safety and respond to risk.
• There was insufficient assurance to demonstrate patients received effective care and treatment. The National Institute for Health and Care Excellence (NICE) guidance was not always followed, clinical performance was not monitored and clinical audit not carried out to evaluate and improve outcomes for patients.
• The majority of patients said they were treated with compassion, dignity and respect.
• There was limited engagement with local commissioners to discuss service improvements.
• Patients reported positively in terms of access to appointments.
• The practice did not actively engage with patients and staff to seek feedback.
• Leadership was fragmented and there was no clear leadership structure in place.

The areas where the provider needs to make improvements are;

Importantly, the provider must:

• Introduce robust procedures for reporting, recording, acting on and monitoring significant events, incidents and near misses, ensure learning is shared with all staff and safety alerts received by the practice are acted on where appropriate. Ensure robust systems are in place for safeguarding children and adults.
• Ensure staff receive appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out their duties they are employed to perform including providing clinical care and treatment in line with national guidance and guidelines.
• Ensure recruitment arrangements include all necessary employment checks for all staff and document all recruitment and employment information in staff files.
• Ensure all vaccine fridges are temperature monitored and daily temperature checks recorded.
• Establish effective systems, including monitoring and regular audit of practice, to meet current guidance to ensure infection prevention and control measures are met and the cleanliness and hygiene of the practice is maintained and assured. Introduce a legionella risk assessment and related management schedule.
• Implement a system to monitor health and safety in the practice including risk assessments for fire and the general environment. Provide staff with fire safety training and carry out regular fire drills to test the fire evacuation procedures.
• Provide access to an automated external defibrillator (AED) or carry out a risk assessment to assess the risk of not having access to this equipment.
• Develop a business continuity plan to ensure continuity of services in the event of a major disruption to the service.
• Proactively monitor the Quality and Outcomes Framework (QOF) performance to steer practice activity and carry out clinical audit to drive improvement in patient outcomes.
• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision. Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which is reflective of the requirements of the practice. Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements. The service must seek and act on feedback from staff, patients and external agencies on the services provided and evaluate and improve their practice in respect of this information.

In addition the provider should:

• Develop a website as an additional means to provide information about the practice to patients.
• Provide more detailed information on the practices’ complaints procedure including external organisations patients can contact.
• Schedule in longer appointment slots for more vulnerable patients.
• Repair the light cord in the disabled toilet.
• Ensure patients are sufficiently involved in decisions about their treatment and care.
• Ensure patients are treated with care and concern by all staff.

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 with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice