New watchdog reports for ex-IMH GPs surgeries

The Abbey Meads Surgery, which was one of two practices taken on by Great Western Hospital NHS Foundation Trust in November, has again been rated inadequate by the Care Quality Commission.

The 18,000-patient GP surgery has been placed in special measures, meaning it will be inspected again within six months. If insufficient progress has been made, the CQC could kick GWH out from managing the service.

However, Moredon Medical Practice, which was also taken on by the hospital trust last year, has been lifted out of special measures – after its rating improved from inadequate to requires improvement. Telephone waiting times had fallen significantly, the CQC found.

GWH boss Kevin McNamara said the ratings reflected the scale of the challenge the hospital took on. “We remain in no doubt that there is a significant amount of work to do to bring these up to the standard that the people of Swindon deserve and this will take time to achieve.”

Abbey Meads Surgery, pictured in 2019 Picture: DAVE COX

Abbey Meads Surgery

In a critical report, published four months after inspectors visited Abbey Meads Surgery in January, the CQC said around 1,000 records had not been summarised, the practice did not have appropriate systems in place to keep patients safe and those registered with the surgery were still experiencing delays.

But the report acknowledged there were improvement plans in place and changes had to be prioritised. Since taking over from IMH in November last year, GWH found problems with governance, the practice’s systems and capacity - meaning improvement plans had to be altered.

Abbey Meads Surgery, which has branches in Penhill and Upper Stratton, was rated inadequate overall. Inspectors graded it inadequate in two categories - for safe and effective care. It requires improvement for responsiveness and leadership while the care staff provided was ranked good. That represents an improvement on the last inspection report, published in July 2019, when it was rated inadequate in all categories but staff care.

In a longer inspection report, the CQC said a backlog of patient records created by IMH had not been fixed, with around 1,000 records dating back to October 2018 that had not been summarised. “The absence of this information may increase the risk of clinicians not having the correct information about a patient at the time of consultation, review or assessment.” There was no plan for when the records would be summarised.

A system to monitor delays in cancer referrals needed improvement, inspectors said. Staff weren’t able to follow-up if patients diagnosed with cancer failed to attend hospital appointments. A plan was in place to address the issue.

Some patients still raised concerns about waiting times, which was a major complaint last year. However, GWH was trying to process correspondence “in a reasonable timeframe”. Under IMH, there had been 680 unfiled documents, such as patient records. That figure had been more than halved.

Staff morale had improved, inspectors said. “They felt supported, were able to contribute towards the improvements and opportunities for development were available.”

Inspectors demand improvements

The CQC said the practice must make improvements to ensure care and treatment is provided in a safe way, ensure staff receive appropriate support and establish effective systems and processes to ensure good governance.

Dr Rosie Bennyworth, CQC chief inspector of primary medical services, said she was placing the surgery in special measures. It would 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.

“Special measures will give people who use the service the reassurance that the care they get should improve.”

Protests outside Moredon Medical Centre in 2018, filmed by TV cameras Picture: DAVE COX

Moredon Medical Centre

Moredon Medical Centre was inspected in February, 12 weeks after GWH took over. A report published yesterday rated the practice as requires improvement, with patient care rated good.

Inspectors noted there was limited monitoring of what happened to patient’s treatment and the practice did not have processes to track hospital referrals. There was a backlog of unreviewed hospital letters and other correspondence.

Actions were being taken to address concerns flagged at last year’s inspection about fire safety.

Significantly, the CQC said patients were able to get appointments quicker than they had done in the past and waiting times on the phone were shorter. This time last year patients reported having to wait up to an hour to get hold of the practice over the phone. Inspectors said yesterday: “Data collected on the day of inspection and submitted by the practice showed that call wait times had reduced significantly.”  

Staff morale was better and work satisfaction had improved, the CQC said. “Staff said they supported with training and career development opportunities.”

Reaction

Reacting to the inspections, GWH chief executive Kevin McNamara said: “I’m pleased that the CQC has recognised the significant improvements we have made within a very short space of time.

“The ratings reflect the enormity of the task we faced at these practices when we took them over, with poor quality care being delivered and very low staff morale.

“We have put a considerable amount of effort into addressing the many issues these practices have experienced. 

“Staff at the practices have been through a huge amount in recent years, but have really risen to the challenge of working to turn the practices around.

“While we have made some great progress, we remain in no doubt that there is a significant amount of work to do to bring these up to the standard that the people of Swindon deserve and this will take time to achieve. The CQC’s reports shows that we are heading in the right direction.”

The hospital trust said it had put in place a number of improvements at the practices, including:

• An increase in nursing staff in both practices to provide more practice nurses and health care support.
• The appointment of a team of practice-based pharmacists
• An increase in on-the day appointments and advance appointments and the introduction of video and telephone consultations during the Covid-19 pandemic.