We carried out an announced comprehensive inspection at Bowburn Medical Centre on 4 April 2019 as part of our inspection programme (previous ratings July 2017 – inadequate, March 2018 – requires improvement).

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.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

• Undertake the planned clinical audits in line with the practice’s audit programme.
• Develop a system for recording and reviewing verbal complaints.
• Continue to act on patient feedback in relation to access to appointments; take steps to publicise the options that patients have when booking appointments and the results of the ongoing appointment audit.

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 Requires Improvement overall. (Previous inspection July 2017 – Inadequate)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Requires Improvement

Are services responsive? – Requires Improvement

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) - Requires Improvement

The population groups are rated as requires improvement overall because we identified areas of concern in the caring and responsive key questions, which have an impact on all population groups. There were, however, examples of good practice.

We undertook an announced focused inspection on 5 October 2017. This inspection was carried out to check whether the provider had taken action to address shortfalls in relation to legal requirements which had been identified at our previous comprehensive inspection. We found that some improvements had been made.

We undertook this announced comprehensive inspection on 8 March 2018 to check that the practice had improved and to confirm they now met legal requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Bowburn Medical Centre on our website at www.cqc.org.uk.

At this inspection we found:

• The practice had made significant progress since the last inspection and had addressed all areas of concern.
• We found improvements in the overall governance arrangements, improved care and treatment for patients and better safety systems and processes
• There were clear systems to keep patients safe and safeguarded from abuse.
• The practice had much improved systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care they provided. They ensured that care and treatment was delivered according to evidence- based guidelines.
• Quality Outcomes Framework (QOF) for 2016/17 showed the practice had achieved 100% of the points available to them for providing recommended treatments for the most commonly found clinical conditions.
• Results from the National GP Patient Survey showed satisfaction levels were below local and national averages, although recent feedback (from the Friends and Family Test and CQC comment cards) contradicted those results. Managers at the practice were working with the patient participation group (PPG) to undertake their own in-house patient survey.
• Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.

The area where the provider should make improvements is:

• Continue to review patient satisfaction and make improvements in relation to access and the wider patient experience.

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

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 Bowburn Medical Centre on 13 July 2017. We identified breaches of four legal requirements. Requirement notices were issued for three breaches and a warning notice for one breach was issued. This focused inspection on 5 October 2017 was to check whether the provider had taken steps to comply with the legal requirements of the warning notice against:

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment.

This report only covers our findings in relation to this requirement. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Bowburn Medical Centre on our website at www.cqc.org.uk.

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

• Action had been taken to address all concerns identified, although the provider should ensure these arrangements are embedded in the way the practice functions.
• A new significant event policy had been introduced which set out the responsibilities of each staff group. Arrangements were put into place to ensure any learning would be shared with relevant staff during clinical meetings and practice team meetings.
• A new system for reviewing patient safety alerts had been implemented and three members of staff had been given responsibility for taking action (two clinical and one administrative).
• Some patients with a learning disability had received a health check; a further patient was booked in to attend imminently. The practice nurse was in the process of contacting the other patients to arrange a time for them to attend, in line with the patients’ preferences. Staff told us all checks would be completed by the end of 2017.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients by making sure the remaining patients with learning disabilities receive health checks by the end of December 2017.

In addition, the provider should:

• Take steps to provide training for staff on the newly implemented policy on significant events.
• Implement a system to document significant events and patient safety alerts to ensure they are all recorded and reviewed as necessary.

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 Bowburn Medical Centre on 13 July 2017. Overall the practice is rated as inadequate.

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

• The practice is run by a partnership. However, only one partner is active at the location; providing a clinical service and leadership with some help from salaried GPs.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• The vast majority of patients said they were treated with compassion, dignity and respect. Some indicators from the National GP Patient Survey relating to patients being involved in their care and decisions about treatment were below local and national averages.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
• Patients did not always have access to appropriate health assessments and checks. None of the ten patients with learning disabilities had received health checks in the previous 12 months.
• There was no recorded evidence to show that patient safety alerts had been actioned and relevant searches carried out to determine if any patients were affected.
• Staff were not always supported to participate in training and development and there were some gaps in management and support arrangements for staff.
• There was a lack of good governance; for example the arrangements for identifying, recording and managing risks, issues and implementing mitigating actions were poor and there was an ineffective system for reporting and recording significant events.
• Staff we spoke with were aware of their own roles and responsibilities.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal 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. Ensure specified information is available regarding each person employed.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards.

In addition, the provider should:

• Take steps to improve access to the premises. The external door did not open automatically and there were no facilities for patients who needed assistance to summon support.
• Review the recent results from the National GP Patient Survey and develop an action plan to address the issues raised.

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