The Care Quality Commission
  • Doctor
  • GP practice

The Elms Medical Practice

Overall: Requires improvement read more about inspection ratings

Tilley Close, Main Road, Hoo St Werburgh, Rochester, Kent, ME3 9AE (01634) 250142

Provided and run by:
The Elms Medical Practice

All Inspections

6 and 7 December 2022

During a routine inspection

This practice is rated as Requires Improvement overall.

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

The full comprehensive report can be found by selecting the ‘all reports’ link for The Elms Medical Practice on our website at www.cqc.org.uk.

Why we carried out this inspection:

We carried out an announced inspection at The Elms Medical Practice on 6 and 7 December 2022 under Section 60 of the Health and Social Care Act 2008, as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

How we carried out the inspection:

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was in line with all data protection and information governance requirements.

This included:

  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Requesting evidence from the provider
  • A short site visit

Our judgement of the quality of care at this service is based 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.

Our findings:

We have rated this practice as Requires Improvement overall.

  • The practice’s systems, practices and processes helped keep people safe and safeguarded from abuse.
  • Some improvements were required to infection prevention and control systems and processes.
  • The provider did not have all emergency equipment that was required to be kept.
  • The arrangements for managing medicines did not always keep patients safe.
  • The practice learned and made improvement when things went wrong.
  • Improvements were required to some types of patient reviews.
  • Staff had the skills, knowledge and experience to carry out their roles.
  • Staff treated patients with kindness, respect and compassion.
  • Staff helped patient to be involved in decisions about care and treatment.
  • People were able to access care and treatment in a timely way.
  • Processes for managing risks, issues and performance required improvement.
  • The practice involved the public, staff and external partners to help ensure they delivered high-quality and sustainable care.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Continue to ensure the practice’s computer system alerts staff of children on the risk register as well as all family and other household members of those children.
  • Continue with planned improvements to the documentation of referrals made under the two week wait system and monitor results.
  • Consider updating reference links in Standard Operating Procedures (SOPs) that are out of date.
  • Continue to ensure patient returned controlled drugs are disposed of in line with legislation.
  • Consider improving staff knowledge of the accessible information standard.
  • Consider formally recording the sharing of learning from all significant events being shared with relevant staff.
  • Continue with ongoing action to improve and / or monitor performance relating to some childhood immunisations and some cancer screening.
  • Continue to implement action plans and monitor improvements to patient satisfaction scores regarding access.
  • Continue to make relevant changes to their registration with the Care Quality Commission in a timely manner.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

Please refer to the detailed report and the evidence tables for further information.

5 September 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Elms Medical Practice on 25 January 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for The Elms Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focussed inspection carried out on 5 September 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 25 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The overall rating for the practice is now good.

Our key findings were as follows:

  • The practice had revised medicines management and introduced a system to help ensure that all prescriptions were signed by a GP before the transfer of the medicine to the patient.

  • High risk substances found in the practice during our last inspection had been disposed of in line with guidance from appropriate bodies.

  • Improvements to risk management had been made and risks to patients were now being assessed and well managed.

  • Records showed the practice was now keeping a record of the photographic identification of all employed staff.

  • The practice had introduced an inventory of the emergency equipment for staff to refer to when carrying out the regular checks.

  • Records showed that all staff had received an appraisal within the last 12 months.

  • The practice had recruited one additional practice nurse who was due to commence employment in November 2017.

  • The practice had identified an additional 21 patients on the practice list who were also carers. The total number of identified patients on the practice list who were also carers was now 100. This represented 1% of the practice list.

  • The practice had continued to implement and evaluate their action plan to improve patient satisfaction with services.

However, there was also one area of practice where the provider needs to make improvements.

The provider should:

  • Implement and evaluate the continuing action plan to improve patient satisfaction with services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

25 January 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Elms Medical Practice on 25 November 2014. The overall rating for the practice was requires improvement. The full comprehensive report on the November 2014 inspection can be found by selecting the ‘all reports’ link for The Elms Medical Practice on our website at www.cqc.org.uk.

After the inspection in November 2014 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

The inspection carried out on 25 January 2017 found that the practice had responded to the concerns raised at the November 2014 inspection and had implemented their action plan in order to comply with the requirement notice issued. However, we found other breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the practice remains requires improvement.

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

  • There was an effective system for reporting and recording significant events.
  • The arrangements for managing medicines in the practice did not always keep patients safe.
  • Risks to patients, staff and visitors were not always assessed and managed in an effective and timely manner.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with said they were able to book an appointment that suited their needs. Pre-bookable, on the day appointments, home visits and a telephone consultation service were available. Urgent appointments for those with enhanced needs were also provided the same day.
  • The practice was equipped to treat patients and meet their needs.
  • The practice was unable to demonstrate they had an effective system to help ensure all governance documents were kept up to date.
  • There was a clear leadership structure and staff felt supported by management. The practice gathered feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are;

  • Revise medicines management and ensure that all prescriptions for controlled drugs (medicines that require extra checks and special storage arrangements because of their potential for misuse) are signed before the transfer of the high risk medicine to the patients.

  • Ensure that the practice is registered to keep the high risk substances that we found in the controlled drugs cabinet or continue to dispose of them in line with guidance from appropriate bodies.

  • Revise risk management and ensure that health and safety risks, fire safety risks and risks associated with legionella are assessed and managed in an effective and timely manner.

  • Revise governance processes and ensure that all documents used to govern activity are up to date.

The areas where the provider should make improvements are;

  • Consider keeping a record of the photographic identification of all employed staff.

  • Implement an inventory of the practice’s emergency equipment to facilitate accurate checking by staff.

  • Revise the system of appraisal in order that all staff receive an annual appraisal.

  • Continue with the process to recruit one additional nurse to help meet patients’ needs.

  • Continue to identify patients who are also carers to help ensure they are offered appropriate support.

  • Continue to implement and evaluate the action plan to improve patient satisfaction with services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

25 November 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the The Elms Medical Practice on 25 November 2014. During the inspection we gathered information from a variety of sources. For example we spoke with patients, interviewed staff of all levels and checked that the right systems and processes were in place.

We did not visit the branch surgeries at:

Allhallows Surgery

Avery Way,

Allhallows,

Rochester,

ME3 9NY.

or

Grain Surgery

Village Hall,

Chapel Road,

Grain,

Rochester,

ME3 0BY.

or

High Halstow Surgery

Recreation Hall,

The Street,

High Halstow,

Rochester.

ME3 8TW

Overall the practice is rated as requires improvement. This is because we found the practice to be good for providing caring and responsive services but it required improvement for leadership and for providing safe and effective services. The concerns that led to the practice requiring improvement for providing safe services applied to all the population groups.

Therefore the practice requires improvement for the care of older people, people with long term conditions, for providing services to families, children and young people, working-age people, people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Staff had received training appropriate to their roles and any further training needs had been identified and relevant sessions planned.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information to help patients understand the services available was easy to comprehend. Staff treated patients with kindness and respect, and maintained confidentiality.
  • Patients said they did not find it easy to get through to the practice on the telephone. However, they were able to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
  • There had not been multi-disciplinary team meetings between the health and social care professionals to address the needs of identified patients discharged from hospital. Although the care plans we looked at in respect of these patients contained all the clinical information required there was not information for how unplanned admissions to hospital might be avoided. The practice did not have documented end of life care plans for those patients who were receiving end of life care.
  • Data showed in all the areas related to the routine management of long term conditions such as diabetes the practice had experienced a severe drop in performance. The practice had fallen from higher than average in the locality to markedly below the national average.
  • The number of patients with dementia who had had a face-to- face review of their care in the preceding year was also was significantly below that achieved locally and nationally.
  • The arrangements for governance and performance management did not always operate effectively. And improvements were not always identified or action taken to improve the quality of care.

There were areas of practice where the provider needs to make improvements.

Importantly the provider must:

  • Carry out an assessment to determine which staff should have a criminal records check via the Disclosure and Barring Service.
  • Review how patients with long term conditions are monitored.
  • Ensure arrangements for clinical governance and quality assurance are in place and followed by all staff according to their job roles.

In addition the provider should:

  • Review the directions provided to staff to assist them in their prescribing practice.
  • Consider how the practice works with other health and social care professionals.
  • Review the telephone access for patients to the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice