Leicester Medical Group v CQC

Factual and Procedural Background

This opinion concerns an appeal by Leicester Medical Group (Appellant) against a decision dated 11 April 2018 made pursuant to Section 31 of the Health and Social Care Act 2008, which imposed conditions on the registration of the Appellant as a service provider at the Thurmaston Health Centre location. The Appellant is a partnership of two doctors, one of whom operated an independent practice without concerns, while the other was responsible for the Thurmaston site.

Following an unannounced inspection in December 2017, several breaches of the Health and Social Care Regulations 2014 were identified, including failures in patient care and treatment, governance, and safeguarding. The practice was rated 'Inadequate' overall and placed into special measures in March 2018. Warning Notices were issued regarding these breaches.

During the hearing in June 2018, the Appellant conceded the appeal against the initial decision, leaving only the question of whether the imposed conditions remained reasonable and proportionate. The Tribunal considered multiple versions of an action plan submitted by the Appellant aiming to address the concerns raised by the Care Quality Commission (Respondent) and the Clinical Commissioning Group.

The Tribunal also dealt with procedural matters such as a restricted reporting order to protect service users' identities and exclusion of a third party from the hearing to avoid adverse effects on witnesses.

Legal Issues Presented

1. Whether the conditions imposed on the Appellant's registration were reasonable and proportionate in light of the breaches identified.
2. Whether the Appellant's action plans were sufficient to mitigate risks to patients and achieve compliance within a reasonable timeframe.
3. The extent to which the Appellant's personnel and management arrangements were adequate to ensure safe and effective service delivery.

Arguments of the Parties

Respondent's Arguments

• Significant risks persisted at the practice despite previous Warning Notices and special measures.
• The April 2018 inspection revealed risks of the highest severity, including risk of death due to failures in monitoring and safeguarding.
• The Appellant's action plans were reactive, lacked detail, and were not workable given personnel issues, particularly the uncertain role of the clinical supervisor and practice manager.
• The partnership showed insufficient insight into the risks and the need for urgent change.
• The Respondent opposed the proposed conditions as neither reasonable nor proportionate and maintained that the Appellant should not provide regulated activities at the Thurmaston location.

Appellant's Arguments

• The action plan had been amended to address criticisms and was reasonable and proportionate as of the hearing date.
• The risk to patients was not so great as to justify restricting practice entirely.
• The Appellant acknowledged past failures and accepted responsibility, demonstrating willingness to implement clear systems and work collaboratively with external partners.
• The Appellant proposed conditions aimed at remedying identified issues, including compliance with Clinical Commissioning Group notices and ongoing revisions to the action plan.
• The Appellant emphasized a cooperative stance and readiness to comply with any imposed conditions and inspections.

Table of Precedents Cited

No precedents were cited in the provided opinion.

Court's Reasoning and Analysis

The Tribunal carefully considered all written and oral evidence, including detailed clinical evaluations and witness testimonies. It noted the Appellant’s concession that breaches had occurred and that initial action plans were inadequate. The Tribunal examined successive versions of the Appellant’s action plan, finding them to lack sufficient detail, robustness, and practicability, especially in key areas such as safeguarding, medicines management, and clinical governance.

The Tribunal assessed the roles and involvement of key personnel, expressing concerns about the capacity and commitment of the Appellant’s partners and staff to implement necessary changes effectively. It highlighted that the Appellant’s evidence showed willingness and good intentions but insufficient understanding and resources to ensure compliance within a reasonable timeframe.

The Tribunal prioritized patient safety and the least restrictive means of regulation, but concluded that the ongoing risks and the inadequacy of the action plan meant that the conditions imposed by the Respondent were justified and proportionate. The Tribunal also considered the position of the Clinical Commissioning Group and the limitations on monitoring imposed by the regulatory framework.

Holding and Implications

The Tribunal's final decision was to confirm the decision of the Respondent dated 11 April 2018, maintaining the conditions on the Appellant’s registration at the Thurmaston Health Centre.

The direct effect of this ruling is that the Appellant must comply with the conditions imposed to address the breaches and risks identified, and the practice remains under special measures. No new legal precedent was established; the decision reaffirms the regulatory framework’s emphasis on patient safety and the necessity of proportionate conditions where compliance is insufficient. The Tribunal’s ruling underscores the importance of effective clinical governance, robust action plans, and clear leadership in healthcare service provision.