The Care Quality Commission
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Cornerstone Family Practice

Overall: Good read more about inspection ratings

Cornerstone Centre, Graham Street, Beswick, Manchester, Greater Manchester, M11 3AA (0161) 223 0637

Provided and run by:
Cornerstone Family Practice

All Inspections

During an assessment under our new approach

Date of assessment: 19 June to 20 June 2024. Cornerstone Family Practice is an NHS GP practice located in Greater Manchester in an area of low deprivation. There were approximately 7890 people registered with the service at the time of our assessment. We conducted this assessment due to concerns found in an earlier inspection. We assessed 5 quality statements across safe, effective, responsive, and well-led key questions and have combined the scores for these areas with scores from the last inspection. At this assessment, we found there was a strong focus on safety and saw managers investigated concerns appropriately. Staff involved people in decisions about their care and treatment and supported them to ask questions. The provider had clear and effective governance systems, which staff regularly reviewed.

no site visit

During an inspection looking at part of the service

We carried out an announced focused inspection at Cornerstone Family Practice on 9 January 2023. We did not rate the practice at this inspection, as due to winter pressures on the NHS it was completed without undertaking a site visit.

Safe - partially inspected and unrated

Effective - partially inspected and unrated

Caring – not inspected

Responsive – not inspected but commented on access for patients

Well-led - partially inspected and unrated

Following our previous inspection on 13 April 2021 the practice was rated good for the effective key question that had been rated requires improvement from the previous inspection on 8 May 2019; overall the practice remained rated good.

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

Why we carried out this inspection

We carried out this inspection to follow up concerns reported to us.

  • We focused on elements of the safe, effective and well-led key questions and asked the provider questions about access to appointments in line with a national initiative.

How we carried out the inspection

This inspection was carried out without visiting the site.

This included:

  • Conducting staff interviews using video conferencing.
  • 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).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.

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:

  • We found that systems to ensure safety of patients were in place but not always working effectively and that this had led to gaps in safe service delivery. Other systems such as staff training were not demonstrated as being effective by the practice.
  • The practice was lower than target for their uptake of childhood immunisations and cervical screening and leaders were unable to provide data that demonstrated any improvement or evidence that any specific actions had been taken to address these.
  • The provider had quality improvement systems in place, but these were generally ineffective.
  • Patient satisfaction with access to care and treatment was generally lower than local and national averages.
  • The practice demonstrated that although governance arrangements were in place, they were often ineffective and reactionary in nature. We saw several areas where gaps were apparent and practice leaders were not always fully aware or had formal plans to address these.

We found a breach of regulations. The provider must:

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

The provider should:

  • Link all other relevant records relating to individual safeguarded children in the clinical system.
  • Update practice information for clinical staff to reflect national prescribing guidance and implement monitoring arrangements.
  • Develop a comprehensive plan to improve cervical screening and childhood immunisation uptake data and monitor.
  • Address patient concerns in relation to access to care and treatment.

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 Hospitals and Interim Chief Inspector of Primary Medical Services

13 April 2021

During an inspection looking at part of the service

We carried out an announced review at Cornerstone Family Practice on 13 April 2021. Overall, the practice is rated as Good, with the rating for the effective key question now updated to good. Patient population groups have also been updated to Good.

Following our previous inspection on 08 May 2019 the practice was rated Good overall and for all key questions apart from effective, which was requires improvement.

Effective was rated as requires improvement due to the practice’s performance data being below local and national averages. We issued the provider with a requirement notice for breach of Regulation 12 (Safe care and treatment) and asked them for an action plan detailing what they would do to improve.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for https://www.cqc.org.uk/location/1-545393907/reports on our website at www.cqc.org.uk

Why we carried out this review

This review was a follow-up of information without undertaking a site visit inspection to follow up on:

  • Original breach identified in Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment was identified.
  • The regulation was not being met due to multiple areas below average in the quality outcome framework (QOF).

Our findings

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

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

We have rated this practice as Good in one domain Effective and the Good overall.

We found that:

  • The overall QOF ratings from 2017/18 had vastly increased by 143 points, seeing improvements in the long-term conditions.
  • The overall QOF score for 2019/20 was 96%.
  • The practice had employed a Data manager to help review and improve in this area.

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

  • Continue further work on improving performance data, in particular cervical screening.

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

8 May 2019

During a routine inspection

We carried out an announced comprehensive inspection at Cornerstone Family Practice, on 08 May 2019. This practice is rated as Good overall. (Previous rating July 2018 – Inadequate)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

The practice was previously given an overall rating of Inadequate on 31 July 2018 with the following domain ratings:

Safe – Inadequate

Effective – Requires improvement

Caring – Good

Responsive – Requires improvement

Well-led – Inadequate

A requirement notice was issued in respect of Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (good governance) and Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (safe care and treatment).

On 30 August 2018 warning notices were issued in respect of Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (safe care and treatment) and Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (good governance). On 3 December 2018 we undertook a focused inspection and the practice had met the legal requirements of the warning notices.

At this inspection we found:

  • The practice had enrolled in the Royal College of General Practitioners (RCGP) special measures peer support programme. The programme provides a bespoke support package, working closely with the practice’s clinicians and senior staff to develop improvement solutions, provide peer support and in-depth reviews and solutions of services.
  • The practice had introduced 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.
  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events with learning outcomes documented.
  • There was a clear leadership structure in place. The practice proactively sought feedback from staff and patients, which it acted on.
  • Every Thursday the practice manager held every Thursday “Meet the practice manager”, which was a one hour drop in session to speak to the practice manager on any issues or concerns they may have.
  • The practice worked within the new Primary Care Network (PCN) where practices shared learning and provided buddy support.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.

We rated the practice as requires improvement for providing effective services because:

  • There were multiple areas below average in the quality outcome framework (QOF).

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way.

The areas where the provider should make improvements are:

  • Continue to increase the number of carers recorded on the practice system.
  • Continue to improve patient experiences to access to services and survey results.

We saw improvement to patient safety and clinical care had significantly improved, with a more structured process and governance system in place to keep staff and patients safe. We were told the aim would be to maintain these standards and continue to improve in areas of quality outcome framework (QOF) and patient access and experiences.

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 MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and the evidence tables for further information.

03/12/2018

During an inspection looking at part of the service

On 31 July 2018 we carried out a full comprehensive inspection of Cornerstone Family Practice, Graham Street, Beswick Manchester,M11 3AA.

The practice was given an overall rating of Inadequate with the following domain ratings:

Safe – Inadequate

Effective – Requires improvement

Caring – Good

Responsive – Good

Well-led – Inadequate

A requirement notice was issued in respect of Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (good governance) and Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (safe care and treatment).

On 30 August 2018 warning notices were issued in respect of Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (safe care and treatment) and Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (good governance). The warning notices stated the provider must be compliant with the regulations by 29 November 2018.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cornerstone Family Practice on our website at .

On 3 December 2018 we undertook this focused inspection to check that the practice had met the legal requirements of the warning notice. We found:

  • The practice had enrolled in the Royal Collage of General Practitioners (RCGP) special measures peer support programme.
  • There had been a new system introduced for reporting and recording significant events. With all staff now aware of how to act on and report events.
  • There was a new process for actioning and completing medicine alerts, overseen by a clinician and clearly documented.
  • GP partners had newly appointed clinical lead roles within the practice.
  • There was a new clinical lead for medicine management and a policy for Hypnotic medicines was in place.
  • There were multiple meetings taking place between all staff, which were minuted and had standard agenda items listed.
  • The practice had discussed clinical audit but were still in the process of formulating dates into the plan.
  • Registration statuses reflected the new clinical partnerships arrangement within the practice.

The rating of inadequate awarded to the practice following our full comprehensive inspection on 31 July 2018 remains unchanged. The practice will be re-inspected and their rating revised if appropriate in the future.

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

Please refer to the detailed report and the evidence tables for further information.

31 July 2018

During a routine inspection

This practice is rated as Inadequate overall. (Previous rating – Requires Improvement November 2017)

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Cornerstone Family Practice on 31 July 2018. This full comprehensive inspection took place following concerns found at the previous inspection resulting in a rating then of ‘Requires Improvement’ Following the inspection of November 2017 we were provided with an action plan detailing how they were going to make the required improvements. This most recent inspection was to measure the improvements made to date.

At this inspection we found:

Some areas within the practice had improved from the previous inspection in November 2017; all staff had now received some training and had access to online training modules. There had been improvements around infection control and fire safety. However, we identified that not all improvements had been made and found new concerns resulting in continuing breaches of regulation.

  • The practice had a number of policies and procedures to govern activity and support the delivery of care. However, we found these processes were not monitored or reviewed in numerous areas, for example, medical alerts.
  • The practice had a newly developed system to manage risk so that safety incidents were less likely to happen. However, we found this not to be consistent with clinical incidents missed and not documented or followed up.
  • The practice did not routinely review the effectiveness and appropriateness of the care it provided. There was little quality assurance taking place in the practice. For example, only two very recent audits had been carried out. These were not two cycle audits and did not show that they were driving quality improvement.
  • A new infection control process and policy had been established with a full practice audit completed and some of the recommendations had been actioned.
  • Staff had completed some online training related to their roles and had access to online training modules. The GP had the correct level of safeguarding training in place.
  • The practice had a newly formed patient participation group (PPG), which had met once.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.

The areas where the provider must make improvements as they are in breach of regulations are:

  • 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.

The areas where the provider should make improvements are:

  • Improve the emergency equipment available at the branch surgery.
  • Improve and increase the numbers of carers on the practice’s carers’ register.
  • Improve staff training to ensure it is completed.

I am placing this service in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.

 

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 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.

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

14 November 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as requires improvement overall. (Previous inspection July 2015 – Good)

The key questions are rated as:

  • Are services safe? – Requires improvement
  • Are services effective? – Requires improvement
  • Are services caring? – Good
  • Are services responsive? – Requires improvement
  • Are services well-led? - Requires improvement

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 – requires improvement
  • People with long-term conditions – requires improvement
  • Families, children and young people – requires improvement
  • Working age people (including those retired and students – requires improvement
  • People whose circumstances may make them vulnerable – requires improvement
  • People experiencing poor mental health (including people with dementia) - requires improvement

We carried out an announced comprehensive inspection at Cornerstone Family practice on 14th November 2017.

At this inspection we found:

  • The practice had a number of policies and procedures to govern activity and support the delivery of good quality care. However, we found these processes were not monitored or reviewed in multiple areas. For example, communication, staff training, HR processes, infection control and Health and Safety.
  • We identified the practice reception had no face to face contact with patients on a daily basis between the hours of 12noon and 4pm.
  • Staff demonstrated that they understood their responsibilities to safeguarding children and vulnerable adults; however on the day of inspection, non-clinical staff had not received training on safeguarding. The clincians safeguarding status was unknown, with the exception of the lead GP who had the information to hand durning the inspection.
  • The practice had no standard internal infection control process or any record of annual audits having taken place at either site. There was no record to show whether staff were screened for or immunised against infectious diseases for example Hepatitis B.
  • The branch surgery had no standard fire safety or infection control processes in place.
  • Staff had not received regular training. Staff who were chaperones had not received any formal training to carry out this role or had Disclosure and Barring Service checks (DBS)or risk assessment in place.
  • Clinical staff were aware of current evidence based guidance. Clinical staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvements as they are in breach of regulations are:

  • 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.

The areas where the provider should make improvements are:

  • Add the full address of the Parliamentary and Health Service Ombudsman (PHSO) to the complaints policy and leaflet.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

4 June 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cornerstone Family Practice on the 4 June 2015.

Overall the practice is rated as good.

Specifically, we found the practice to be good for providing, safe, effective, caring, and well led services.

It was also good for providing services for the populations groups we rate.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored and reviewed.
  • Risks to patients were assessed and managed.
  • Patients’ needs were assessed and care was planned in line with best practice guidance.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients said they could make an appointment with a named GP, with urgent appointments available the same day.
  • The practice was equipped to treat patients and meet their needs.
  • Staff felt supported by management.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • A more robust programme of clinical audits should be developed to demonstrate positive outcomes for patients.
  • Prescription pads should be securely stored.
  • The lead for safeguarding should complete training to level 3.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During a check to make sure that the improvements required had been made

At the last inspection on 22 August 2013 concerns were raised about the way staff were being recruited. The full employment history of one staff member had not been checked and there was no evidence of interview notes or pre- employment identity checks being obtained in any of the staff files. While Criminal Record Bureau checks were in place for all four doctors, these checks had not been completed for reception staff who acted as chaperones for female patients and so were involved in direct patient care.

The provider submitted an action plan which outlined how they intended to address these issues. The action plan stated that a new recruitment process would be implemented in order that future staff appointments were made in a standardised manner ensuring the best person for the job was recruited. A system had also been set up to check the recruitment process was followed in a fair and robust manner.

22 August 2013

During a routine inspection

On the day of our inspection we were only able to speak to one patient. For some of the patients attending the morning surgery English was not their first language or they were not happy to talk to us. The patient we spoke with spoke positively about the practice and commented that they were happy with the care they received. Their comments included, 'I wouldn't want to change my doctor' and 'they talk everything through with you'.

We saw that all the consulting rooms were on the ground floor of the building and they were accessible to people with limited mobility. The practice was clean and there was ample seating available in the waiting area for patients. Leaflets and a television monitor in the waiting area provided patients with information about the services available.The practice leaflet also provided patents with information about how to raise a concern or complaint.

The practice had an electronic patient records system in place to record the contact patients had with the service.Procedures were in place documenting communication processes and information exchange with other healthcare professionals and services. This meant that the care of the people who use the service was coordinated.

The practice did not have an up to date recruitment policy in place.This meant that the practice could not demonstrate that it carried out effective recruitment processes. The practice ensured that all staff employed were registered with the relevant professional body.