This practice is rated as Requires Improvement overall. (Previous rating March 2018 – Inadequate)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – Requires Improvement

Are services responsive? – Requires Improvement

Are services well-led? - Good

We previously carried out an announced comprehensive inspection of Upton Lane Medical Centre on 1 March 2018. This was to follow up concerns identified during a prior inspection which was undertaken on 21 November 2016.

The overall rating for the practice at the March 2018 inspection was inadequate and the service was placed in special measures for a period of six months. The full comprehensive report from the inspection undertaken on 1 March 2018 can be found by selecting the ‘all reports’ link for Upton Lane Medical Centre on our website at .

As a result of our findings from the March 2018 inspection CQC issued requirement notices for the identified breaches of Regulations 12, 18 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Specifically, we found concerns related to: the completion of safeguarding updates and mental capacity act training, the storage of liquid nitrogen, systems to ensure safety alerts were acted upon, lack of appropriate checks of equipment, systems to address infection control risks, medicines management, governance. In addition, we found that older people were not receiving appropriate regular health checks. Systems were not operating effectively including those to ensure to appropriate utilisation of cancer referral pathways, management of significant events and complaints and support for carers. The service had also not taken adequate action in response to below average national GP patient survey results.

This inspection was undertaken within six months of the publication of the last inspection report as the practice was rated as inadequate and placed in special measures. This was an announced comprehensive inspection completed on 25 October 2018. Overall the practice is now rated requires improvement.

At this inspection we found:

The provider had taken action and had addressed most of the concerns from the previous inspection.

For example:

• The practice had clear 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. We saw that there were systems now in place to act upon safety alerts and the infection control concerns had been addressed and prescriptions and refrigerated medicines were now being managed safely.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence - based guidelines. The service had worked to increase the number of cancers detected using the two week wait referral pathway and the number of older persons health checks had increased. There was action taken to reduce higher than average levels of antibiotic prescribing and a diabetic specialist consultant had been employed to improve the care and enable the service to achieve clinical targets in this area.
• The practice had put in place mecahnisms to support carers and increase the numbers of carers on their register to 5%.
• We found that governance arrangements had improved.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

However:

• Although we obtained evidence that staff involved and treated patients with compassion, kindness, dignity and respect, both the latest national GP patient survey and the service’s own internal survey indicated that patient satisfaction in this regard was below local and national averages. The practice had undertaken training and planned to undertake further training to improvement patient satisfaction.
• Most of the patients we spoke with on the day of the inspection found the appointment system easy to use and reported that they were able to access care when they needed it. This feedback was also reflected in the CQC comment cards. However, both national patient safety data and data from the practice’s internal survey showed that many patients had difficulty accessing appointments. The service had taken and was planning to take further action to improve action particularly around telephone access.
• The service was not achieving targets related to cervical screening and childhood immunisations.

The areas where the provider must make improvements are:

• 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 work to ensure appropriate prescribing of antibiotics.
• Continue with work to improve early detection of cancers using the two week wait referral pathway.
• Review mechanism for identifying prevalence of patients hypertension who meet the criteria for treatment with statins.

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

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

This practice is rated as Inadequate overall. (Previous inspection 21 November 2016 – Requires improvement)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Inadequate

Are services responsive? – Requires improvement

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 comprehensive inspection at Upton Lane Medical Centre on 21 November 2016 and rated the practice as requires improvement for caring, responsive and effective, good for safe and well-led services, and requires improvement overall. The full comprehensive report on the 21 November 2016 inspection can be found by selecting the ‘all reports’ link for Upton Lane Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection at Upton Lane Medical Centre on 1 March 2018 as part of our inspection programme to follow up on breaches of regulations and areas to improve identified in our previous inspection. This report covers our findings at the follow up inspection on 1 March 2018.

Our key findings at this 1 March 2018 inspection:

• Risks to patients were not assessed and well managed including legionella, equipment, fire safety, and infection control.
• The percentage of patient new cancer cases referred using the urgent two week wait referral pathway was significantly below average, and patients who were carers were not identified or supported effectively.
• Systems for identifying and managing safety alerts and significant events were ineffective or had weaknesses.
• Patient survey feedback was consistently below local and national averages and not understood or followed up effectively.
• Prescriptions were not secured or their usage monitored and refrigerated vaccines were unfit for use.
• Staff recruitment checks were undertaken but there were gaps in staff training including safeguarding and mental capacity for clinical staff.
• Clinical performance was generally comparable to national averages and staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Patients experienced ongoing difficulty getting through on the phone and getting an appointment and did not feel involved in decisions about their care or treated patients with compassion, kindness, dignity and respect.
• Information about services and how to complain was available and easy to understand but limited improvement was made to the quality of care following patient feedback.
• Governance systems were not implemented or ineffective.

The areas of practice 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.

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 Upton Lane Medical Centre on 21 November 2016. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed however we identified risks to the safe care and treatment of patients due to high levels of exception reporting for certain conditions.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients we spoke with said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. However this was not reflected by the results of the GP patient survey, the results of which were significantly below local and/or national averages.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP, however this was not reflected by results of the GP patient survey. 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Review its levels of and processes for exception reporting and take all necessary steps to improve outcomes for patients.

The areas where the provider should make improvement are:

• Continue to seek and act on feedback from patients on the services provided for the purposes of improving patient satisfaction with the quality of service provided.

• Put measures in place to encourage patients who are carers to identify themselves.

• Flag patients who are carers on the patient database to ensure staff take their particular needs into account.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice