Agenda item

Representatives of Prospect Surgery and the Clinical Commissioning Group to provide an update on the surgery’s recent inspection by the Care Quality Commission.

The Chair welcomed Drs Saleem and Kesavalu and Mrs Jane Henderson from Prospect Surgery as well as Dr Nanda as Clinical Director of the Central Middlesbrough Primary Care Network and Karen Hawkins as Director of Commissioning, Strategy and Delivery (Primary & Community Care).

 

The Chair emphasized that the panel’s intention was to act as critical friend in this matter.

 

The Director of Commissioning explained to members that the CQC was a regulatory independent body for health and social care services. The CQC had produced an inspection report that identified Prospect GP surgery had been found to be inadequate in three domains.

 

It was explained that the CQC ordinarily carried out announced visits with GP Practices usually receiving two weeks’ notice of such an inspection. The CQC inspection in this case was unannounced and carried out in July 2021 with the resulting report produced in September. There were three areas of focus within the report; safety, effectiveness and well-led with all three areas found to be inadequate. The inspection did not inspect the caring and responsive elements of the practice but did find two breaches of regulation specifically regulation 12 regarding safe care and treatment as well as regulation 17 regarding good governance. The practice had until the 1^st October 2021 to respond to the former and the 6^th December 2021 for the latter breach.

 

Members were informed that the practice had put robust action plans in place to address the issues in the report and that the Local Medical Committee, Local GP Federation and the CCG were all working to support Prospect. It was recognized that remedial action was required to reassure patients and reinforce their confidence in the practice.

 

Importantly, while the CCG would be supporting the practice with their action plans they were not a regulator and as such would be not be signing off any responses to the CQC.

 

Naturally, the practice were disappointed with the outcome of the report but were working hard to ensure any failings were being remedied. It was also noted that the CQC could, within the next six months, carry out a further inspection should any further concerns be raised. The panel were reassured that the practice has positively engaged with the CQC and they were able to remedy several of the issues identified in the report.

 

Representatives from Prospect GP practice advised the panel they were thankful for the opportunity to address members. Members heard how the practice had been previously rated as good by the CQC and there was a number of factors that contributed to the most recent rating. Those factors included the impact of the Covid-19 pandemic which led to some patients having to isolate and refusing to attend their usual appointments. Similar impacts were felt due to staff isolation which resulted in staff shortages at critical times, especially during the vaccination programme.

 

Importantly, changes to how patients were monitored for chronic diseases meant reviews were not being carried out as they should have been. There were also challenges in recruiting staff to key posts, namely nurses, and where recruitment was possible, there was often a need to train those staff which took time. However, the practice had put temporary measures in place to reduce impact on patients while this process continued.

The practice had also appointed a new pharmacist which would assist in areas including medication reviews and management of high-risk drugs. 

 

The Covid Pandemic had also meant a shift to virtual meetings with patients which presented significant challenges for the practice, but this pressure was now easing.

 

The practice was also meeting fortnightly with all staff to ensure a degree of transparency. Individual teams within the practice now had a named lead and there was also a degree of oversight from the practice manager which would allow for a more joined up way of working.

 

Overall, the practice was disappointed with the outcome of the report but were committed to delivering safe and effective care to its patients.

 

The chair again emphasised that the panel were acting as a critical friend and would provide what assistance they could.

 

The panel was advised that the surgery was previously inspected in 2015 and 2017 with both ratings being good. It was also clarified that in terms of nurse recruitment several of Prospect’s Practice Nurses had left their positions creating vacancies. Recruitment to those vacancies was difficult owing to shortages in those positions. When those positions were filled, however, it was with district nurses who required training to carry out important procedures such as cervical screening and childhood vaccinations.

 

A member asked the practices’ representatives to identify key indicators from the inspection that would inform how to avoid a return to the conditions experienced at the time of the inspection.  

 

The practice stated that some of the factors leading to the rating were outside of its control, but once those circumstances return to normal with Covid-19 restrictions easing the processes and mitigations explained previously should be sufficient to avoid a repeat of the latest inspection results.

 

It was queried why the practice seemingly prescribed a high number of opioids which were ordinarily prescribed to patients with drug or alcohol abuse issues. The practice clarified that the appointment of a pharmacist would assist with core drug prescribing. However, prescribing opioids was not just for those with drug or alcohol abuse problems they were also prescribed for pain, usually prescribed by a specialist pain clinic. As such the practice was often prescribing such drugs to patients but did not initiate those prescriptions.

 

The practice was also using guidance issued by the National Institute of Clinical Excellence and their own internal guidance to try and reduce prescribing drugs of that nature. The practice was also engaging with those patients in receipt of that kind of painkiller.

 

Given Prospect Surgery’s location in the town centre, and the larger number of deprived communities it serves, a member commented that the Public Health Service had been asked to conduct a mapping exercise that would help understand patient demographics which could inform what other services may be required for the area.

 

Members were reassured that due to the actions being put in place by the practice should the CQC conduct another unannounced inspection in the near future a good rating would be found.

 

The clinical director for the Central Middlesbrough Primary Care Network and Executive GP on the Primary Care Quality Team advised she had sight of Prospect’s action plan and was assured that with the assistance of the other practices in the Central Middlesbrough Network the relevant remedial action could be taken.

 

While members were reassured by the comments made by prospect surgery there remained concerns regarding how the community would be affected especially those with long term illnesses and the seemingly large number of children that were not receiving their routine vaccinations.

 

As such the panel felt an interim update be provided before required six month deadline in December. It was agreed that the CCG would return to the panel with an update on progress against the action plan three months from the meeting. 

 

Prospect surgery thanked the panel for its constructive feedback.

 

ORDERED that:

 

1) The Public Health Service develop a usage map to understand patient usage that could inform future service provision

2) The CCG provide the panel with an update report no later than three months hence and

3) The information presented be noted.