Archived: Pinehill Surgery

We carried out an announced comprehensive inspection at Pinehill Surgery on 17 September 2019. We previously inspected the practice on 24 January and rated Pinehill Surgery as inadequate overall. The practice was placed into special measures. This inspection was within six months of the previous inspection and was to determine whether the practice had made sufficient improvements to come out of special measures or whether further action was needed by CQC to close the practice.

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, patients, the public and other organisations.

We have rated this practice as requires improvement overall. We have rated Safe, and Well-led as requires improvement and Effective, Caring and Responsive as good.

We rated the practice as requires improvement for providing safe and well-led services because:

• There continued to be a shortage of administrative/reception staff since the last inspection and although systems were working more effectively, staff continued to feel under pressure.
• We found gaps in the security system for blank prescription stationery.
• Evidence did not demonstrate that safety alerts were consistently responded to appropriately.
• We identified information governance breaches during the inspection.
• The practice had not displayed its rating from the previous inspection on either its website or on its premises where patients could see it.

We rated the practice as good for providing effective, caring and responsive care because:

• Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
• The practice now had an improved programme of quality improvement activity, demonstrating significant improvement since the last inspection.
• Staff worked together and with other organisations to deliver effective care and treatment.
• Staff treated patients with kindness, respect and compassion. Feedback from patients was now positive about the way staff treated people.
• The practice now organised and delivered services to meet patients’ needs.

We rated all population groups, apart from working age people, as good because:

• The practice had created and maintained patient registers, since the last inspection, which enabled them to monitor patient care and provide care which was bespoke to individual population groups such as six monthly reviews.
• The practice now followed up on older patients discharged from hospital.
• Patients with long-term conditions were offered a structured annual review to check their health and medicines needs were being met.
• The practice now had arrangements for following up failed attendance of childrens’ appointments following an appointment in secondary care or for immunisation.
• Patients could book or cancel appointments online and order repeat medication without the need to attend the surgery.
• Homeless patients were now offered immediate and urgent appointments.
• Alerts were now added to the medical records of patients with a mental health diagnosis, so staff could offer quieter appointment times.

We rated population group working age people, as requires improvement because:

• The practice had a low cancer detection rate resulting from two week wait referrals.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure the most recent rating is displayed conspicuously and legibly at each location delivering a regulated service and on their website

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Improve systems to identify and support carers.
• Implement a programme of two cycle audit.Consider how to meet the needs of patients with a hearing impairment, such as a hearing loop.
• Develop a practice leaflet to inform patients about the practice and services available to them.
• Improve systems for the reporting of incidents to nclude use of clinical commissioning group monitored systems.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of General Practice

We carried out an announced comprehensive inspection at Pinehill Surgery on 23 January 2019. The inspection was brought forward from a later planned date due to intelligence received.

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, patients, the public and other organisations.

We have rated this practice as Inadequate overall. We have rated Safe, Caring and Well-led as inadequate and Effective and Responsive as Requires Improvement.

We rated the practice as Inadequate for providing safe, caring and well led services because:

• Leaders had been unable to sustain the previous level of quality achieved at our last inspection. There was no evidence of continuity.
• There was no ownership of quality improvement.
• Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.
• The practice had a clear vision, but it was not supported by a credible strategy.
• The practice culture did not effectively support high quality sustainable care.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• The practice did not involve the public, staff and external partners to sustain high quality care.
• There was little evidence of systems and processes for learning, continuous improvement and innovation.
• The practice did not have clear systems, practices and processes to keep people safe and safeguarded from abuse.
• The practice did not have systems for the appropriate and safe use of medicines.
• Feedback from patients was not always positive.
• The practice scored poorly in the 2018 GP survey and had not taken action to address the concerns raised by patients.

We rated the practice as Requires Improvement for providing effective and responsive because:

• The practice was unable to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
• The practice did not consistently organise and deliver services to meet patients’ needs, although there were some areas of good practice.
• People were able to access care and treatment in a timely way.

We rated all population groups, apart from people whose circumstances make them vulnerable as Requires Improvement overall because:

• The practice were unable to evidence regular meetings with external parties such as community palliative care team or health visitors.
• The practice had not met the 90% World Health Organisation (WHO) target for child immunisation and had not demonstrated actions taken to address this.
• The practice had not been responsive to the needs of older patients, patients with long term conditions, people whose circumstances made them vulnerable and people experiencing poor mental health by ensuring priority appointments, keeping registers and providing appropriate training for staff.
• There was not effective monitoring of high risk medicines.

We rated the population group working people whose circumstances make them vulnerable as Inadequate overall because:

• The practice was not actively identifying and monitoring vulberable people to keep them safe.

The areas where the provider must make improvements are:

• Care and treatment must be provided in a safe way for service users.
• Ensure that the premises used by the service provider are safe to use for their intended purpose.
• Ensure the proper and safe management of medicines.
• Assess the risk of preventing, detecting and controlling the spead of infections.
• Ensure systems and processes are established and operated effectively to ensure compliance with the requirements of the Health and Social Care Act 2008.
• Recruitment procedures must be established and operated to ensure that the information specified in schedule 3 is available in relation to each person employed.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review systems to identify vulnerable adults so they are regularly monitored.
• Monitor prescription requests to ensure that prescriptions for high risk medicines and medicines required to maintain positive mental health are collected in a timely way.
• Provide appropriate support for patients identified as carers.
• Carry out regular patient surveys and develop action plans as a result.

I am placing this service in special measures. Services placed in special measures will 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. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. 

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration. 

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice