Heartbeat Alliance

Updated 11 July 2023

Heartbeat Primary Care Community Interest Company works with GP Practices in the Hambleton Richmondshire and Whitby areas to offer a wider range of appointments between 6:30pm - 8pm Monday to Friday and 9am – 5pm on Saturdays and 9am – 1pm on Sundays. This is part of the enhanced access service required to be provided by Primary Care Networks as part of the NHSE Network Contract Directed Enhanced service (DES). They serve a population of approximately 145,575 patients. From the 1 October 2022 Heartbeat Alliance has been sub-contracted to deliver the enhanced access service on behalf of the Primary Care Network.

The focus of this inspection was the delivery of the enhanced access service, which has been operational since November 2017. Enhanced access (also referred to as extended access) was rolled out as a national target for all primary care to improve access to General Practice routine appointments.

The enhanced access service is provided from 13 sites:

Great Ayton Surgery, Rosehill, Great Ayton, Middlesbrough, TS9 6BL

Monday 6.30pm to 8pm and one Saturday per month 9am – 12pm

Mowbray House Surgery, Malpas Road, Northallerton, North Yorkshire, DL7 8FW

Tuesday 6.30pm – 8pm

Tuesday and Thursday (1:3 per month) 6.30pm – 8pm

Stokesley Health Centre, North Road, Stokesley, TS9 5DY
Tuesday 6.30pm – 8pm

Mayford House Surgery, Boroughbridge Road, Northallerton, North Yorkshire, DL7 8AW

Thursday 6.30pm – 8pm

Friarage Hospital, Northallerton DL6 1JG

Thursday (1 per month) and Friday 6.30pm – 8pm, Saturday 9am – 5pm and Sunday 9am – 1pm

Lambert Medical Centre, 2 Chapel Street, Thirsk, YO7 1LU

Monday and Thursday (1:3 per month) 6.30pm – 8pm

Glebe Medical Practice, 19 Firby Road, Bedale, North Yorkshire, DL8 2AT

Tuesday 6.30pm – 8pm

Thirsk Doctors Surgery, The Health Centre, Chapel Street, Thirsk, YO7 1LG

Wednesday and Thursday (1:3 per month) 6.30pm to 8pm and alternate Saturdays 9am – 12pm

Doctors Lane Surgery, Aldbrough St John, Richmond, DL11 7TH

Monday 6.30pm – 8pm

Quakers Lane Surgery, Quakers Lane, Richmond, DL10 4BB

Tuesday 6.30pm – 8pm

Harewood Medical Practice, The Health Centre, 42 Richmond Road, Catterick Garrison, North Yorkshire, DL9 3JD

Wednesday and Thursday 6.30pm – 8pm

Saturday 9am – 5pm and Sunday 9am – 1pm

Central Dales Practice, Aysgarth Surgery, Aysgarth, Leyburn, North Yorkshire, DL8 3AA

Friday 6.30pm – 8pm

Saturday (1:4 per month) 9am – 5pm

Whitby Hospital, Springhill, Whitby, YO21 1DP

Monday to Friday 6.30pm – 8pm

Saturday 9am – 5pm

We visited two of these locations; Thirsk Medical Centre and Harewood Medical Practice. We also visited the head office of Heartbeat Primary Care Community Interest Company.

The extended access service delivers remote and face-to-face consultations dependent on patient choice.

Heartbeat Primary Care Community Interest Company operates from Suite 26, Evolution Business Centre, County Business Park, Darlington Road, Northallerton, DL6 2NQ. There is an organisation Board structure. All work on a part-time basis. Day to day operational management for enhanced access is provided by a Clinical Operations Manager. The majority of staff are employed by Heartbeat on a sessional basis.

Heartbeat Primary Care Community Interest Company – Heartbeat Alliance is registered with the Care Quality Commission to provide the regulated activities diagnostic and screening procedures, treatment of disease, disorder or injury and family planning.

Updated 11 July 2023

We carried out an announced comprehensive inspection of the extended access service run by Heartbeat Primary Care Community Interest Company at various sites across Hambleton, Richmondshire and Whitby from 17 to 18 May 2023. Overall, the provider is rated as requires improvement.

Safe - Requires improvement

Effective – Good

Caring – Not inspected, rating of good carried forward from previous inspection

Responsive - Good

Well-led – Requires improvement

Why we carried out this inspection

We carried out an announced focused inspection at Heartbeat Alliance to follow up on breaches of regulation identified at our previous inspection. At the last comprehensive inspection in May 2022, we rated the practice as requires improvement overall, requires improvement for safe and effective, good for caring and responsive and inadequate for well-led. This was because the provider:

• did not ensure that care and treatment was always delivered in a safe way for patients
• did not ensure persons employed in the provision of the regulated activity received the appropriate support, training, professional development, supervision, and appraisal necessary to enable them to carry out their duties
• did not ensure effective systems and processes were in place to ensure good governance in accordance with the fundamental standards of care

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• conducting staff interviews via face to face, video conferencing and requesting feedback from staff electronically
• requesting evidence from the provider
• reviewing patient records to identify issues and clarify actions taken by the provider
• a site visit to the head office and two sites where the service is delivered from

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected.
• information from our ongoing monitoring of data about services; and
• information from the provider, staff, and other organisations.

We have rated this provider as requires improvement overall.

We found that

• At our last inspection in May 2022, we rated the provider as requires improvement for providing a safe service. This was because there was a lack of oversight in respect of recruitment, training, equipment and premises, significant events, patient safety and alerts, prescription security, business continuity planning; and the ability to respond to a medical emergency. At this inspection we found improvement in some but not all of the above areas. Some areas had been addressed such as access to emergency equipment, prescription security and security alerts for example. However, many of the changes had only recently been introduced and not fully embedded/implemented.
• At our last inspection in May 2022, we rated the provider as requires improvement for providing an effective service. This was because we identified concerns relating to quality improvement, including clinical and prescribing audit and the arrangements for ensuring staff had the skills, knowledge, and experience to carry out their roles. At this inspection we found improvement in all areas.
• We rated the service as good for providing responsive services at the last inspection. We continued to rate the service as good for providing responsive services.
• At our last inspection in May 2022, we rated the provider as inadequate for providing a well-led service as systems and processes to demonstrate effective oversight and good governance were not in place. At this inspection we found improvement in terms of the day-to-day management of the enhanced service. However. we found the continued lack of capacity at management and executive level to be able to fully embed and support the changes that were being introduced/needed.

The area where the provider must make improvement is:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services