Harris Memorial Surgery

We carried out an announced focused inspection at Harris Memorial Surgery on 18 May 2023. Overall, the practice is rated as inadequate.

Safe - inadequate,

Effective - requires improvement,

Caring - good,

Responsive - requires improvement,

Well-led - inadequate.

Following our previous inspection on 13 April 2018, the practice was rated good overall and for all key questions. At this inspection, we found that those areas previously regarded as good had not been continued. While the provider had maintained some good practice, the threshold to achieve a good rating had not been reached. The practice is therefore now rated inadequate.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Harris Memorial Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up in response to information shared with us and in line with our inspection priorities.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews using video conferencing facilities.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Speaking with staff.
• Speaking with patients.
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.

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, patients, the public and other organisations.

We found that:

• The practice did not have clear systems, practices and processes to keep people safe and safeguarded from abuse. There were gaps in systems to assess, monitor and manage risks to patient safety and staff did not have the information they needed to deliver safe care and treatment. The practice did not always share learning or improvements when things went wrong.
• There were inadequate systems to assess, monitor and manage risks to patient safety and appropriate standards of cleanliness and hygiene were not met.
• More work was required to ensure all aspects of medicine management were safe.
• There were gaps in the system to manage significant events and complaints.
• Patients’ needs were assessed and the care and treatment provided was delivered in line with current legislation, standards and evidence-based guidance although not all patients had access to health checks.
• There was limited monitoring of the outcomes of care and treatment. The practice did not have a comprehensive programme of quality improvement activity and did not routinely review the effectiveness and appropriateness of the care provided.
• The practice could not demonstrate that all staff had the skills, knowledge and experience to carry out their roles.
• The numbers of cervical screening carried out in the practice had not met national targets.
• There was limited involvement in local and national quality improvement initiatives or clinical auditing.
• People were not always able to access care and treatment in a timely way. The practice always obtained consent to care and treatment in line with legislation and guidance. Complaints were listened and responded to. However, records did not consistently demonstrate how the complaint was investigated and it was not clear how learning from complaints was shared to improve the service.
• There was not effective leadership at all levels. The practice did not have a clear vision and credible strategy to provide high quality sustainable care.
• The overall governance arrangements were ineffective. The practice did not always act on appropriate and accurate information and there were no clear and effective processes for managing risks, issues and performance. The practice involved the public and staff to a limited extent. There was little evidence of systems and processes for learning, continuous improvement and innovation.

We found three breaches of regulations. The provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The provider should:

• The provider should implement a system to clearly identify the outcome and action taken following any safety checks or audits.
• The provider should take action to provide staff with clarity on the process for the dissemination of information contained within safety alerts.
• The provider should implement a system to enable patients to access relevant health checks.
• The provider should improve patient confidentiality in the reception area and take action to reduce the risk that confidential conversations between clinicians can be overheard.

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 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 may lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Healthcare