We carried out an announced comprehensive inspection at Littletown Family Medical Practice on 12 February 2019 as part of our inspection programme. We previously inspected the practice 17 March 2015 and the practice was then rated as good in all domains.

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 inadequate overall.

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

• The practice did not have clear systems and processes to keep patients safe.
• The practice had only recently carried out its first infection control audit and did not have a plan in place to make the improvements required. Not all staff had received infection control training.
• A general fire risk assessment had been carried out in February 2010 and had not been updated. There was only one trained fire warden.
• Staff had incorrect information about checking medicine fridge temperatures, so actions had not been taken when the temperature was outside the safe range.
• Some sharps bins were not wall-mounted and had been opened since May 2017.
• Significant events were not adequately managed so learning was not identified or disseminated.
• The practice did not have sight of completed Disclosure and Barring Service (DBS) checks for all clinicians.
• The practice did not check that medical indemnity insurance was in place for all clinicians.
• The practice did not have a system to check the ongoing professional registration status of clinicians.

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

• The practice was unable to show that all staff had the skills, knowledge and experience to carry out their roles.
• The practice did not provide a formal induction for new staff.
• Staff did not receive ongoing supervision or regular appraisals of their performance so training and development needs were not identified.

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

• There was a lack of privacy in some clinical consultation rooms. Conversations could be overheard, and one door had an unobscured window.
• The practice had identified a low number of patients who were carers (0.1%) so appropriate support could not be offered.

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

• The system for managing complaints was not effective. Not all complaints were investigated or responded to, and where complainants did receive a response they were not provided with all the appropriate information. We saw no evidence of learning from complaints.

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

• The arrangements for governance did not always operate effectively. For example, we saw examples of generic policies not being personalised to the practice, and policies that had been reviewed but were not being followed.
• We saw examples of ineffective performance management. The practice manager had never had an appraisal and appraisals for other staff were irregular. Some tasks that had been delegated were not being performed.
• There was a limited approach to obtaining the views of patients. The patient participation group was not active and a patient survey carried out in early 2017 had not been repeated.
• Although the majority of recruitment checks were being carried out there was no system to monitor ongoing checks.
• Risks, issues and poor performance had not been identified and so had not been dealt with.

These areas affected all population groups so we rated all population groups as requires improvement.

The areas where the provider must make improvements are:

• Ensure the privacy of the service user.
• Ensure there is an accessible system for identifying, receiving, recording, handling and responding to complaints.
• 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:

• Take action to increase the number of patients who are carers.
• Formalise the programme of clinical audits so they are well-recorded and reviewed.
• Relaunch the patient participation group so patient’s view can be collected.
• Ensure sharps bins are secure and sealed within the appropriate time.

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.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Littletown Family Medical Practice on 17 March 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

Our key findings across all the areas we inspected 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.

• Risks to patients were assessed and appropriately managed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• 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.

• Patients said they found it easy to make an appointment with a named GP and that 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.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

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

Importantly the provider should:

• Ensure that the legionella risk assessment that has been in place for a significant period of time is reviewed.
• Ensure fire drills are undertaken periodically and recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice