Letter from the Chief Inspector of General Practice

On 16 June 2016 we carried out a comprehensive inspection at Aegis Medical Centre. Overall the practice was rated as inadequate and placed in special measures for a period of six months. The practice was found to be inadequate in safe, effective and well led, requires improvement in responsive and good in caring.

As a result of that inspection we issued the practice with a warning notice in relation to the governance at the practice. The issues of concern related to the safe recruitment of clinical staff, appropriate training and supervision of clinicians, monitoring of patients subject to safeguarding concerns, including following up children who do not attend for their hospital appointments and improving patient outcomes. These included implementing formal governance arrangements including systems for assessing, monitoring and mitigating risks. Whilst ensuring the quality of the service provision such as through the appropriate actioning of patient information, medicine and safety alerts. Medicine reviews were required to be conducted in a timely manner by an authorised person.

We then carried out a focused inspection of the practice on 7 December 2016 to establish whether the requirements of the warning notice had been met. We found improvements had been made but further were required to ensure the safe management of medicines. The practice was issued with a requirement notice for improvement.

We then carried out an announced comprehensive inspection at Aegis Medical Centre on 21 March 2017. Overall the practice is rated as good.

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

• Staff were able to recognise and report significant incidents. These were investigated and lessons learnt identified and shared during clinical and practice management meetings attended by all staff.
• The practice had improved their prescribing behaviour. Patient safety and medicine alerts were shared amongst the clinical team and consistently actioned.
• All clinical staff had DBS checks completed enabling them to practise independently.
• The practice was actively following up on children and vulnerable persons who failed to attend clinical appointments. Where appropriate they worked within multidisciplinary teams to identify and address concerns.
• The practice had improved their clinical performance in respect of QOF.
• The practice planned for staff absence to ensure minimal disruption to services for patients.
• The practice had a formal induction programme for new staff and all staff had received appraisals and training and development within their roles
• The practice had reviewed their patient’s attendance at accident and emergency services to use it to inform and improve the delivery of their services.
• The practice held regular multi-disciplinary team meetings in addition to coordinated care through the patient record system.
• Data from the national GP patient survey showed patients reported high levels of satisfaction with the practice nursing team and had trust and confidence in their GPs.
• Carers were identified and supported to access services and receive appropriate vaccinations.
• Patients reported improved access to the clinical team. The practice had opened up the availability of appointments to patients, enabling them to book three weeks in advance with the GPs. They could also speak to the GPs on the telephone and/or attend evening surgery held twice monthly.
• The practice team shared a vision to providing high standards of care. Staff had been spoken to regarding the GP partner’s aspirations for the practice.
• The GP partners reviewed the performance of the practice weekly during clinical meetings
• There was a defined leadership structure, staff understood their roles and responsibilities and how these contributed directly to improving patient experiences of the service and the practices performance.
• The practice GP partners attended patient participation group meetings and had listened and responded to patient feedback.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

On 16 June 2016 we carried out a comprehensive inspection at Dr NG Newport‘s Practice now known as Aegis Medical Centre. Overall the practice was rated as inadequate and placed in special measures for a period of six months.

As a result of that inspection we issued the practice with a warning notice in relation to the governance at the practice. The issues of concern were as follows;

• Non clinical staff were reviewing, prioritising and filing clinical information independently of clinical input.
• The practice was an outlier for prescribing medicines within their CCG.
• The practice had failed to ensure the safe prescribing of medicines
• The practice Quality Outcome Framework (QOF) performance was below the local and national levels
• Data for the national cancer intelligence network showed the practice had lower rates of screening for their eligible patients.
• The practice had above the local average for accident and emergency admissions.
• The practice did not consistently code patients who failed to attend hospital appointments and follow up with them to check on their welfare.
• The provider had failed to assess, monitor and improve the quality and safety of services. For example; difficulties obtaining appointments and poor engagement by the GP partners with their patient participation group.
• The practice confirmed there were no arrangements in place to cover the full extent of the practice nurse responsibilities in their absence.

The practice was required to be compliant with the warning notice by 20 October 2016. We conducted a focused inspection of the practice on 7 December 2016 to establish whether the requirements of the warning notice had been met. We found;

• Non clinical staff were no longer reviewing, prioritising and filing clinical information.
• The practice had improved their prescribing practices and were no longer an outlier for prescribing medicines wirthin their CCG. However, we found high risk medicines were not being appropriately monitored and patient safety and medicines alerts were not being appropriately actioned.
• The practice had improved their QOF performance compared to local and national levels.
• The national cancer screening data for 2015/2016 showed improved attendance by eligible patients. It was comparable or above local and national averages for breast and bowel cancer.
• The practice had above the local average for accident and emergency admissions.
• The provider had improved their assessment, monitoring and improvement of the quality and safety of services. The GP partners had met with their PPG and improved the availability of appointments for patients.
• The practice had revised their scheduling of nurse appointments to plan for absence and a GP partner was to undertake additional training to perform their duties.
• The practice was actively reviewing attendance by their patients at out of hours, accident and emergency and walk in services. They coded their attendance and followed up with them to ensure their needs were being met.

The areas where the provider must make improvements are:

• Ensure the effective and safe management of high risk medicines and consistent actioning of patient safety and medicine alerts.

The practice had complied with the majority of the issues identified at the first inspection but further improvements were required in relation to their medicines management. The practice will remain in special measures until their reinspection in 2017. 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr NG Newport’s Practice on 16 June 2016. Overall the practice is rated as inadequate.

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

• Patient safety and medicines alerts were shared amongst the clinical team but not consistently actioned. Some patients remained on medicines contrary to guidance and some medication reviews had not been appropriately authorised. The practice was an outlier within Basildon and Brentwood CCG for their management of medicines.
• The practice had an appointed safeguarding lead and staff had received appropriate training. However, there was no clear system to alert members of staff to potential patient vulnerabilities. The practice told us they followed up with parents and guardians of children who had not attended hospital appointments in order to identify whether they were at risk. However, we found no entries on the clinical system to support this.
• The practice had a below local and average clinical performance in QOF achieving 71% of the points available. They also had high accident and emergency attendance rates and low patient screening rates for bowel and breast cancer.
• There was no documented induction programme for new staff and some members of clinical staff had not received disclosure and barring service checks. Other members of the practice team were found to be reviewing and prioritising clinical information without clinical oversight.
• Patients reported they had trust and confidence in their GPs but experienced difficulties obtaining appointments with them. We found there was a lack of available GP appointments for patients and high rates of patients failing to attend for appointments.
• The practice had a complaints policy and procedure that was consistent with guidance and best practice. We found complaints were responded to and investigated in a timely and appropriate manner.
• The practice had a shared commitment and vision to providing high standards of care. Staff and the PPG spoke highly of the professionalism of the practice manager.

The areas where the provider must make improvements are:

• Ensure clinical staff are DBS checked prior to commencing independent clinical duties.
• Ensure appropriately trained and supervised clinicians receive and review all clinical information.
• Improve the monitoring of patients subject to safeguarding concerns, including following up children who do not attend for their hospital appointments.
• Monitor and work to improve patient outcomes in QOF. For example, in relation to patients with long term conditions and those suffering with poor mental health.
• Implement formal governance arrangements including systems for assessing, monitoring and mitigating risks and ensuring the quality of the service provision such as through the appropriate actioning of patient information, medicine and safety alerts and conducting medicine reviews in a timely manner by an authorised person.

The areas where the provider should make improvement are:

• Ensure sufficient staffing to maintain clinical duties in a staff members absence.
• Ensure staff receive an induction to undertaking their role and responsibilities and this is documented.
• Review attendance by their patients at out of hours, accident and emergency and walk in service to identify trends and use it to inform the delivery of their services.
• Respond to patient feedback in relation to the availability of GP appointments.
• Continue to monitor and improve prescribing patterns.
• Increase the uptake of patients attending for the national screening programme for breast and bowel cancer.

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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice