Two GP practices in the East Midlands have been placed in special measures after being rated “inadequate” by the Care Quality Commission.
Inspectors identified “significant areas of concern” at the Trent Valley Surgery in Lincolnshire, rating it inadequate for safety and leadership and for work with specific patient groups including older people and those with long-term conditions.
The rural surgery, serving families living in and around the village of Saxilby where it is based, is staffed by two GPs, a nurse practitioner, nurse and healthcare assistant.
“Not all patients [prioritised for chronic disease management] had a named GP, a personalised care plan or structured annual review”
CQC report on Trent Valley Surgery
Issues raised by the CQC team included inadequate measures to deal with medical emergencies and staff, including nurses, not knowing where to find the nearest supply of oxygen.
Staff were also unclear about reporting incidents, near misses and concerns and the practice did not have a system in place to ensure GPs and nursing staff routinely referred to best practice guidance on care and treatment.
Nursing staff had lead roles in chronic disease management with patients at risk of hospital admission identified as a priority.
“However, not all these patients had a named GP, a personalised care plan or structured annual review to check that their health and care needs were being met,” said the CQC in its report on the practice.
“These failures have either been resolved or are being addressed. We now have a new practice management team in place”
Trent Valley Surgery statement
Inspectors also pinpointed good practice especially around palliative care and found the surgery’s good working relationship with district nurses was benefitting the most seriously ill patients. Overall they rated the practice “good” for caring.
A statement from the Trent Valley Surgery said the failures identified by the CQC were mainly related to practice management.
“These failures have either been resolved or are being addressed,” said the statement. “We now have a new practice management team in place.
“The CQC has rated the surgery as good in relation to providing caring services and, with the support of our staff and Lincolnshire West clinical commissioning group, we will continue to provide exceptional care for our patients.”
Meanwhile Dr NHR Simpson’s Practice in Loughborough was rated “inadequate” for safety, effectiveness, responsiveness and leadership and “requires improvement” for caring.
Staff at the practice in Barrow-Upon-Soar, Loughborough, include three specialist nurses, a minor illness nurse, diabetes nurse and a healthcare assistant.
Inspectors found patients were at risk because the practice – based at the Barrow Health Centre – did not have all the necessary systems and processes in place, including checks on staff references, qualifications and registration. There was also no induction process for nursing staff.
“[The practice] did not carry out thorough investigations when things went wrong”
CQC repport on Dr NHR Simpson’s Practice
Inspectors found the practice “did not carry out thorough investigations when things went wrong” and there had not been an infection prevention audit since 2012 despite minor surgery having been carried out on the premises each week.
“We were told that one of the nurses was now the lead for infection control although when we spoke with that staff member they were unaware of this,” said the CQC’s report on the practice, which found there was no clear leadership structure.
Dr Nick Simpson, one of the GPs at the practice, said the team was striving to address all the issues highlighted by CQC.
All staff working for the practice and as part of multi-disciplinary teams were being re-screened “giving greater assurance to patients that they are being treated by experienced and appropriately qualified clinical staff”, he said.
There was a new practice manager in place as well as a raft of new systems and processes to address safety and monitoring concerns.
“Staff are our greatest asset as we are enhancing their training, professional development and appraisals”
Dr Nick Simpson
“Staff are our greatest asset as we are enhancing their training, professional development and appraisals,” added Dr Simpson.
West Leicestershire clinical commissioning group said it was supporting the practice, including helping update data systems to improve care for people with long-term conditions.
“The CQC report has identified that patients felt they had been treated with compassion, dignity and respect and the practice demonstrated that they value feedback from patients,” said Evan Rees, the CCG’s independent lay member for patient and public engagement.
“We want to help the practice ensure these positive experiences are built on and are pleased they have a patient participation group that they are working with who are supportive of the changes the practice is making,” he added.
Both practices placed in special measures will be required to make improvements within six months or their registration with the CQC will be at risk.