The Care Quality Commission
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Archived: Bath Lodge Practice

Overall: Good read more about inspection ratings

Bitterne Health Centre,, Southampton, Hampshire, SO18 6BT (023) 8044 2111

Provided and run by:
Bath Lodge Practice

All Inspections

13 March 2019

During a routine inspection

We carried out an announced comprehensive inspection at Bath Lodge Practice on 13 March 2019 as part of our inspection programme.

We carried out an announced comprehensive inspection at Bath Lodge Practice on 12 October 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months.

As a result of the inspection a warning notice was served. The practice was re inspected in March 2017 to follow up on the warning notice and was found to have completed the requirements of the notice.

Following the period of special measures, we carried out an announced comprehensive

inspection on 7 June 2017. We found that the practice had significantly improved when we undertook the follow up inspection on 7 June 2017. However, the practice needed time to ensure that there was more evidence that the improvements were embedded properly and that the improvements were sustained.

We rated the practice as requires improvement overall, with requires improvement in the Effective, Caring and Responsive domains.

We had carried out an announced focused inspection at Bath Lodge Practice on 6 February 2018. We found that the practice had continued to improve. The practice was rated good overall and required improvement in the Caring domain.

At this inspection were saw that improvements had been made in the Caring domain, but the practice required improvement in Well led and the population group of patients with long term conditions.

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 good overall and good for all population groups apart from the population group of patients with long term conditions.

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs.
  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learnt from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment were delivered according to evidence- based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.

Whilst we found no breaches of regulations, the provider should:

  • Continue to improve Quality Outcome framework performance and in particular in the population group of people with long term conditions and the percentage of women eligible for cervical cancer screening.
  • Continue to Improve patient experience feedback.
  • Review the procedures and recording of printer locations of blank prescriptions
  • Ensure an application for a new registered manager is made within 28 days.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

6 February 2018

During an inspection looking at part of the service

This practice is rated as Good overall. (Previous inspection 06/2017 –Requires Improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Requires Improvement

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced focused inspection at Bath Lodge Practice name on 6 February 2018. This was to check that the practice had made required improvements in the domains effective, caring and responsive to people’s needs. These domains were found to require improvement at our previous inspection in June 2017.

At this inspection on 6 February 2018 we found that:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines.
  • All staff received up-to-date safeguarding and safety training appropriate to their role.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • There was a focus on continuous learning and improvement at all levels of the organisation.
  • The practice had an Advanced Nurse Practitioner (ANP) who visited two residential homes for patients with severe learning disability, ensuring that their acute medical needs were met and that they had regular routine health checks.
  • There was a system for receiving and acting on safety alerts. The practice learned from external safety events as well as patient and medicine safety alerts.

The areas where the provider should make improvements are:

Continue to review the care and treatment offered for all patients with long term conditions such as demonstrated through the Quality and Outcomes Framework results.

Review the patient experience and take account of feedback such as the national GP patient survey results.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

7 June 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bath Lodge Practice on 12 October 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Bath Lodge Practice on our website at www.cqc.org.uk.

As a result of the inspection a warning notice was served. The practice was re inspected in March 2017 to follow up on the warning notice and was found to have completed the requirements of the notice.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 7 June 2017.

We found that the practice had significantly improved when we undertook the follow up inspection on 7 June 2017. However, the practice needs time to ensure that there is more evidence that the improvements are embedded properly and that the improvements are sustained.

Overall the practice is now rated as requires improvement.

Our key findings were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and managed.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Since our inspection in October 2016 all the GP partners had left the practice and Bath Lodge Practice has new partners and formed Bath Lodge Practice under the brand of Integral Medical Holdings (IMH). The practice had two new male partners and four female salaried GPs. The clinical team were supported by a new practice manager who was being supported by an interim practice manager and 20 receptionists, secretaries, administrators, support officers and a medicines manager.
  • There was a new leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • Risks assessments for areas such as fire and infection control had been carried out, and there was a system to monitor and act on the findings of the assessments.
  • Practice policies and procedures were now appropriately reviewed and updated to ensure their content was current and relevant.
  • Systems and processes for ensuring all staff were suitably trained had been addressed and the practice had ensured that all staff had the necessary skills and competencies to carry out their role.
  • Systems were now in place to monitor the cleanliness of the premises and protect patients from risk of infection.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

There were areas where the practice should make improvement.

The practice should monitor and review the 2016-2017 collected scores for the Quality and Outcomes Framework (QOF) to improve performance against national screening programmes and to monitor outcomes for patients.

The practice should review and work to improve the national GP patient survey which showed patients rated the practice comparable or lower to other practices for several aspects of care.

The practice should continue to review and improve patient’s ability to make an appointment with a named GP to improve continuity of care.

The practice should continue in its efforts since October 2016 to increase the number of identified patients as carers at present this was just over 1% of the practice population.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

9 March 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced focussed inspection at Bath Lodge Practice on 9 March 2017 to follow up on a warning notice.

Our previous inspection in October 2016 was a comprehensive inspection and we rated the practice inadequate overall and this will remain unchanged until we undertake a further full comprehensive inspection within six months of the publication date of the initial report. As a result of the inspection a warning notice was served. The timescale given to comply with the warning notice was 28 February 2017.

The warning notice served related to regulation 17 Health and Social Care Act as a result of the following issues:

  • The practices efforts were focused on providing urgent and emergency appointments which meant the needs of all patients, such as those requiring non-urgent appointments, could not be fully considered and responded to.
  • There was limited evidence of quality improvement including improvements driven by full cycle clinical audits. Information provided by the practice showed only one full cycle clinical audit had been completed in the last two years. Other audits provided showed no improvement over time in the quality of service provided.
  • The infection control audits were insufficient.
  • There were not sufficient systems to ensure that staff had appropriate support, including induction training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.
  • There was insufficient leadership to govern change and development within the practice. An effective oversight of the practices performance was not maintained and there was no clear arrangement for the day to day management of the practice in the absence of the practice manager.

At our inspection on 9 March 2017 we found the provider had complied with the warning notice in relation to regulation 17.

Our Key findings were:

There were now more systems and processes in place; for example

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risk assessments for areas such as fire and infection control had been carried out, and there was a system to monitor and act on the findings of the assessments. Systems were now in place to monitor the cleanliness of the premises and protect patients from risk of infection.
  • Practice policies and procedures were now appropriately reviewed and updated to ensure their content was current and relevant.
  • Systems and processes for ensuring all staff were suitably trained had been addressed and the practice had ensured that all staff had the necessary skills and competencies to carry out their role.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The practice now offered a mixed model of appointments. They offered more routine appointments which were made available up to two weeks ahead.
  • They were introducing a patient streaming system. Receptionists had a template indicating when they should offer patients appointments for specific conditions.
  • Since our last inspection Integral Medical Holdings (IMH) become the provider and the practice had three new male partners, three female salaried GPs, with a further female salaried GP starting at the practice in May 2017.
  • There were two Advanced Nurse Practitioners, two full time practices nurses and a locum practice nurse. There were also three Health care assistants.
  • The clinical team was supported by a new practice manager who was being supported by an interim practice manger and 20 receptionists, secretaries, administrators, support officers and a medicines manager.

Professor Steve Field

CBE FRCP FFPH FRCGPChief Inspector of General Practice

12/10/2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bath Lodge Practice on 12 October 2016. Overall the practice is rated as inadequate.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Information about services and how to complain was available and easy to understand.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Clinical staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • The practice did not have sufficient, processes and practices in place to keep patients safe at all times. Not all staff had the right skills, knowledge or experience to do their job. The learning needs of staff were not fully understood. Staff were not always supported to participate in training and development. There were staff shortages.
  • There was limited evidence of quality improvement including clinical audit. Very few clinical audits or other quality improvement measures had been undertaken in recent months.
  • There was a limited approach to obtaining the views of patients who used the services and there was minimal engagement with patients, staff or the public. The practice had no active patient participation group (PPG). The feedback we saw and gathered from patients was mixed; most negative comments were about booking appointments.
  • Staff satisfaction was mixed. Staff said they did not always feel actively engaged or empowered and there were low levels of staff satisfaction.

  • Appointment systems were not working well, the system of triage when requesting appointments via reception did not follow any agreed protocol and lacked oversight. There was insufficient clinical capacity and an inadequate number of appointments available for pre-booking. However, some routine and bookable extended hours appointments were available through the practice at the local federations GP practice hub located in one of four practices locally.

  • On the day of inspection the partners and management in the practice were unable to demonstrate they had the capacity and capability to make measurable and sustainable change to ensure high quality services for patients.

The areas where the provider must make improvements are:

  • Ensure adequate arrangements with regard to infection prevention and control.

  • Ensure adequate clinical appointments and related staffing to meet the needs of the practice patient list.

  • Improve on performance with regard to outcomes for patients.

  • Ensure the provision of an appropriate induction programme for all newly appointed staff and training regarding safeguarding, reception triage and infection control.

  • Ensure there is day to day management strategy for the governance of the practice and overall leadership for the delivery of all improvements to promote safe practice, quality improvement, learning and innovation.

The areas where the provider should make improvements are:

  • Review systems and processes for how carers are appropriately identified and supported.

  • Review systems and processes for how complaints are dealt with to ensure a timely response.

  • Review systems, processes and measures taken to act on patient feedback and the findings from staff, current measures were not resulting in service improvement.

  • Review systems and processes for how emergency contact numbers for staff are provided to ensure they are easily accessible as part of the practice’s business continuity plan.

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.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice