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

We carried out an announced comprehensive inspection at Apex Medical Centre on 6 November 2018 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.

At this inspection we found:

• There was an effective system for reporting and recording significant events.
• The practice’s systems, processes and practices did not always help to keep people safe and safeguarded from abuse.
• Risks to patients, staff and visitors were not always assessed and managed in an effective manner.
• Staff had the information they needed to deliver safe care and treatment to patients.
• The arrangements for managing medicines in the practice did not always keep patients safe.
• The practice learned and made improvements when things went wrong.
• The practice had a programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care they provided.
• The practice was unable to demonstrate that all staff were up to date with essential training.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.
• There were clear responsibilities, roles and systems of accountability. However, governance arrangements were not always effective.
• The practice had systems and processes for learning, continuous improvement and innovation.
• There was a focus on continuous learning and improvement at all levels of the organisation.

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.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

• Continue with plans to apply for funding to replace clinical wash-hand basins in the practice that do not comply with Department of Health guidance.
• Continue to monitor and improve performance for blood pressure related indicators and uptake of the cervical screening programme.
• Record, investigate and where possible learn from verbal complaints.
• Continue with the application process to register a Registered Manager with the Care Quality Commission.
• Continue with activities to set up a patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Apex Medical Centre on 21 July 2015. Breaches of the legal requirements were found. Following the comprehensive inspection, the practice wrote to us to tell us what they would do to meet the legal requirements in relation to the breaches.

We undertook this focussed inspection on 14 April 2016, to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Apex Medical Centre on our website at www.cqc.org.uk.

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 of Apex Medical Centre on 21 July 2015. Overall the practice is rated as good.

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, reviewed and addressed.
• Most risks to patients were assessed and well managed.
• Patient’s needs were assessed and care was planned and delivered in line with current legislation. Staff had received training appropriate to their roles.
• 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 understand. Staff treated patients with kindness and respect, and maintained confidentiality.
• Patients said they experienced few difficulties when making appointments and urgent appointments were available the same day.
• There was a leadership structure and staff felt supported by management. The practice took into account the views of patients and those close to them as well as engaging with staff when planning and delivering services.

However, there were areas of practice where the provider needs to make improvements.

Importantly the provider must;

• Review the storage of blank prescription forms and ensure that all medicines and vaccines held are within their expiry date.
• Review infection control risk assessment and management to ensure the practice complies with national infection control guidance.
• Ensure the practice is able to respond to medical emergencies in line with national guidance.
• Ensure annual physical health checks and medicine reviews are offered to all patients with learning disabilities.
• Ensure that records that contain confidential patient information are held securely so that only authorised staff can access them.

The provider should also;

• Revise the availability of opening hours’ information to patients when the practice is closed.
• Raise staff awareness of the practice statement of purpose.
• Revise governance processes and ensure that all documents used to govern activity are up to date and contain relevant contact details.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Our inspection on 19 November 2013 found that people who used Apex Medical Centre were not always protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We found that the centre had a copy of the local Kent and Medway safeguarding policy for safeguarding adults that was out of date. Staff we spoke with told us that they had received training in safeguarding adults and children. However, we did not find any documented evidence that any training updates in safeguarding adults and children had been provided for all members of the staff team. At the time of our visit we could not verify whether administrators who acted as patient chaperones when other clinical staff were not available, had had police checks or disclosure and barring service (DBS) checks since beginning their employment. A risk assessment had not been completed regarding administrative staff acting as chaperones.

A compliance action was set asking the provider to take action regarding these concerns. They wrote to inform us that they had taken action and put measures in place to rectify the areas of concern found at this inspection.

We followed up on our inspection of November 2013 to check that action had been taken to meet the compliance action set. We found that Apex Medical Centre was able to demonstrate that they were meeting the compliance action set in order to rectify the areas of concern identified at that inspection.

Apex Medical Centre is operated by two GPs working in partnership and they are assisted by a salaried GP, regular locum GPs, two nurses, a health care assistant, two phlebotomists (a person who takes samples of blood), a practice manager and nine administrative staff.

During our visit we spoke with the practice manager, a phlebotomist, a nurse and four patients.

People we spoke with were happy with the care and treatment they received at the centre. People spoke highly of the staff and all of the people said that "Booking appointments is easy."

We found that people's needs were assessed and care and treatment provided was discussed with patients and delivered to meet their needs. People spoke positively about their experiences of care and treatment at the centre.

We found that there were child and adult safeguarding policies and procedures in place. Staff were knowledgeable in both safeguarding adults and children. We found that staff who chaperone people during invasive procedures did not have criminal record checks in place.

We found that people were protected from the risks associated with infection because appropriate procedures or equipment were in place.

Medicines were kept safely. However, there were no formal processes to ensure the security of prescription pads.

There were formal mechanisms and documentation in place to indicate that the centre was able to monitor or assure the quality of the service people received.