Emersons Green Medical Centre

We carried out this inspection following our annual review of the information available to us, which indicated that there may have been a significant change (either deterioration or improvement) to the quality of care provided since the last inspection. We also followed up on the breaches of regulation 17 HSCA (RA) Regulations 2014, identified at the previous inspection 5 December 2018. This inspection looked at the following key questions:

Are services Safe?

Are services Effective?

Are services Caring?

Are services Responsive?

Are services Well-led?

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.

At the last inspection in December 2018 we rated the practice as good overall and requires improvement for providing well-led services because: the provider had failed to establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care, in breach of Regulation 17 HSCA (RA) Regulations 2014 and a requirement notice was issued.

At this inspection, we found the provider had taken appropriate action to address the requirement notices from the last inspection.

We have rated this practice as requires improvement overall, with a rating of requires improvement for safe, effective, caring, well-led and inadequate for responsive.

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

• Patient Specific Directions were managed in line with legal requirements
• There was a backlog in summarising patient records back to November 2018.
• There were inconsistencies in the way prescription security was managed across sites e.g. at Emersons Green Medical Centre the sign out sheet for blank prescriptions did not involve a record of serial numbers.
• Not all clinical waste (sharps) bins had been disposed of in line with best practice guidelines.

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

• Exception rate reporting for some population groups was higher than local and national averages e.g. long-term conditions, including diabetes and COPD.
• The Public Health England target for cervical screening uptake, within the working age people population group had not been met.

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

• Staff did not always treat patients with kindness, respect and compassion.
• Patients expressed concerns about the way some of the reception staff dealt with them whilst trying to access services or book appointments.
• Performance indicators from the national GP survey relating to care and treatment as well as the overall patient experience of the GP practice was below local and national averages.

We rated the practice as inadequate for providing responsive services because:

• There were significant constraints on the ability of people to access care and treatment in a timely way via the telephone system, resulting in some performance indicators being significantly below local and national averages. We saw the practice had taken steps to improve performance in this area, through the introduction of a new care navigation system, together with increased appointment times of 15 minutes, in response to patient feedback, however the impact had not been reviewed at time of inspection.

The inadequate areas found during inspection impacted on all population groups within the responsive domain, we have therefore rated all population groups as inadequate overall.

We rated the practice as requires improvement for providing well-led services because:

• The practice had restructured the leadership and management team so that leaders had time to focus on service development and patient needs. They understood the challenges facing them and had improvement plans in place to address them, however the leadership and governance arrangements in place were not fully embedded across all locations. This led to safety concerns and inconsistences in record keeping and systems.

The areas where the provider must make improvements are:

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

(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 monitor and improve the uptake of cervical screening for disease prevention.
• Continue to monitor and improve areas of high exception reporting.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as Good overall. (Previous rating April 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

We carried out an announced comprehensive inspection at Emersons Green Medical Centre on 5 December 2018 as part of our inspection programme.

At this inspection we found:

• There had been a significant change in the leadership at the practice since April 2017. The practice had recognised that sustainability and succession planning were needed to ensure the continued safe running of the practice. To facilitate this, they had recently merged with a local practice so that running costs, some administrative work and clinical teams could be used across the organisation and ensure the continued level of service provision. This had involved a complete restructuring process which was on-going at the time of the inspection.
• We found that the practice had established policies, procedures and activities to ensure safety but did not always have systems in place to monitor and assure themselves that they were operating as intended. For example, the processes for incidents and complaints were not always followed by staff.
• Staff treated patients with compassion, kindness, dignity and respect; feedback from patients supported these comments.
• Patients feedback through the national GP patient survey (2018) indicated that they experienced delays in being able to access routine care when they needed it.
• The provider had been responsive to the national GP patient survey (2017) and had introduced an urgent care team so that any patient contacting the practice for an urgent appointment had a telephone consultation with a clinician who then directed them to the most appropriate care.
• There was a focus on continuous learning and improvement within the organisation

The areas where the provider must make improvements are:

• 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;

• Risk assess appointment availability to reduce waiting times for routine appointments.
• Continue to monitor and improve the uptake of cancer screening for disease prevention.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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