We carried out an announced comprehensive inspection at Loughton Health Centre on 27 March 2018. At that inspection, we rated the practice as inadequate because systems had not been established to monitor and mitigate risks to patients. The overall rating for the practice was inadequate and they were placed in special measures for a period of six months.

We served warning notices in respect of the governance and safety at the practice. At a focused inspection of 21 August 2018, we found that the practice had met the requirements of these warning notices.

We carried out an announced comprehensive inspection at Loughton Health Centre on 4 December 2018 to check that improvements had been made. At this inspection, we found that the practice had taken positive steps to respond to risk and implement sustained improvements. They were working closely with stakeholders and action plans were being systematically reviewed.

We based our judgement of the quality of care at this service is 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.

The full comprehensive reports of the March 2018 and August 2018 inspections can be found by selecting the ‘all reports’ link for Loughton Health Centre on our website at

https://www.cqc.org.uk/location/1-566522029

.

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

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

• Whilst action plans had been implemented to improve performance, up to date data had not yet been published to confirm this. Therefore, we could not yet be assured that patients with long term conditions and those suffering with poor mental health had been effectively monitored. Continued action was necessary to evidence that required improvements had been made.

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

• Whilst changes had been made with a view to improving access to the practice, continued action was necessary to evidence that required improvements had been made and patient satisfaction improved, as up to date data was yet to be published. This affects all the population groups.

The area where the provider must make improvements is:

• 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:

• Continue to monitor and improve patient feedback in relation to accessing the practice.
• Update the fire risk assessment to detail remedial action taken.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

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

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Inadequate

Are services well-led? - Inadequate

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 – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those recently retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

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

We carried out an announced inspection at Loughton Health Centre on 27 March 2018. This took place as part of our inspection programme.

At this inspection we found:

• There were not effective systems for keeping vulnerable adults and children safeguarded from abuse.
• Staff who acted as chaperones had not received a DBS check or risk assessment to ascertain their suitability for the role.
• The practice did not routinely carry out required staff checks on recruitment.
• There was not an effective system to manage infection prevention and control.
• The systems to check emergency equipment required review and improvement. The practice had not carried out an appropriate risk assessment to identify emergency medicines that it should stock.
• There were adequate systems for reviewing and investigating when things went wrong.
• The practice was not monitoring prescription stationery as it was distributed in the practice.
• There was not an effective system to respond to MHRA alerts and patients were identified as at risk.
• Staff did not always prescribe, administer or supply medicines to patients in line with current national guidance. The practice did not identify and recall patients who were prescribed medicines that required additional monitoring.
• There was no health and safety risk assessment. Staff had not received health and safety training. Non-clinical staff had not received safeguarding vulnerable adults training.
• Not all staff had received an appraisal of their performance.
• Prescribing for some antibiotics was higher than the CCG and England average.
• The practice did not have effective systems to keep clinicians up to date with current evidence-based practice. There were ten patients aged over 35 who smoked and were being prescribed the oral contraceptive. This was contrary to NICE guidelines.
• Members of the nursing team had recently begun attending a nurses’ forum, where they would meet with other practice nurses in the locality every month.
• The practice did not have a comprehensive programme of quality improvement activity.
• QOF data for 2016/17 was below average in respect of asthma checks and blood pressure checks for patients with diabetes, hypertension. The practice was also below average for some mental health indicators. Unverified data for 2017/18 did not indicate consistent improvement.
• The practice did not offer a health check for patients aged over 75. They had completed a health check for only one out of 23 patients with learning disabilities in the last year.
• Following our inspection, the practice implemented systems to share information more effectively regarding patients who were at the end of their lives.
• The practice had identified 161 patients as carers which amounted to 1% of the practice list.
• On the day of our inspection, patient feedback was positive about the care from the clinicians; however, some patients continued to raise concern about accessing services.
• The complaints policy was not available to patients accessing the practice website.
• Leadership was inadequate as there was a lack of oversight and implementation of effective policies and procedures.
• The practice worked with other practices in the locality.

The areas where the provider must make improvements as they are in breach of regulations are:

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

The areas where the provider should make improvements are:

• Continue to take steps to improve feedback in the GP patient survey
• Ensure all staff have a recent appraisal of their performance.
• Make the complaints policy easily accessible to patients using the practice website.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Loughton Health Centre on 07 April 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for all of the population groups we looked at.

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 action taken where required.
• Risks to patients were assessed and well 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 were planned for.
• 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.
• Some patients and reception staff commented that it was occasionally difficult to obtain appointments. Urgent appointments were available the same day and emergencies prioritised.
• 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 sought feedback from patients through a well-supported patient participation group that was consulted about improving services.

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

Importantly the provider should;

• Establish a system to obtain patient feedback about the services provided from a broader selection of patients, such as a patient survey or other means.

• Hold more regular team meetings with non-clinical staff to ensure they have the opportunity of providing feedback and are aware of other issues that may affect their role.

• Ensure that clinical and non-clinical audit cycles are completed in order to demonstrate improvements have been maintained.

• Ensure the complaints system is readily available for patients to access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Professor Steve Field CBE FRCP FFPH FRCGP