Archived: Five Elms Medical Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Five Elms Medical Practice on 5 April 2016. Overall the practice is rated as inadequate.

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 and actions to address concerns with infection control practice had not been taken.
• When there were unintended or unexpected safety incidents, reviews and investigations were not thorough enough and lessons learned were not communicated widely enough to support improvement. People did not always receive a verbal and written apology .
• Improvements to patient outcomes were hard to identify as little or no reference was made 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.
• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

• Take action to assess the risk of, prevent, detect and control the spread of infections.
• Take action to assess the risks associated with fire.
• Carry out a risk assessment to determine if staff who act as chaperones need a DBS check.
• Ensure there is an effective system in place for the receipt and distribution of safety alerts to all staff.
• Ensure there are processes for identifying where improvements in clinical care can be made and monitored.
• Take effective and sustainable action in response to patient feedback relating to lack access to the service, difficulties obtaining suitable appointments , involvement in decisions about their care and explanations of tests and treatments.
• Ensure that all staff receive training about confidentiality and information governance
• Ensure staff are supported with and receive professional development, supervision, training and appraisal to enable them to undertake their role.
• Provide appropriate training to staff required to carry out chaperone duties.
• Ensure that all staff receive appropriate training on infection prevention and control.
• Ensure recruitment arrangements include all necessary pre-employment checks for all staff.

The areas where the provider should make improvement are:

• Provide staff with appropriate and up to date policies and guidance, which are reflective of the requirements of the practice.
• Review current interpretation services to ensure these are available to patients on request.
• Review arrangements for involving staff in the vision and strategy for the practice and in making improvements in how the practice is run.
• Review the complaints process to ensure it is easily accessible by patients.
• Review arrangements for identifying and supporting carers.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take 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 varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration. Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice