Hilltops Medical Centre

We carried out an announced inspection at Hilltops Medical Centre on 15 October 2019 as part of our inspection programme. We decided to undertake an inspection of this service following our annual review of the information available to us. This inspection looked at the following key questions:

• Safe
• Effective
• Well-led

At the last inspection in November 2018 we rated the practice as good overall and requires improvement for providing safe services because:

• Risks to patients and staff had not adequately been assessed and monitored, in particular with regard to infection prevention and control and blank prescription stationery security.
• The practice did not evidence a consistent approach to recruitment through the provision of appropriate recruitment records.

At this inspection, we found that the provider had taken some action to improve in these areas. In particular, concerns with blank prescription stationery security had been resolved.

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 and good for all population groups. The practice was rated as requires improvement for providing safe and well-led services.

We found that:

• 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 way the practice was clinically led and managed promoted the delivery of high-quality, person-centre care.
• There was a clear leadership structure. However, support for effective practice management was lacking. The practice proactively sought feedback from staff and patients, which it acted on.
• There was evidence of continuous learning and improvement at all levels of the organisation.

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

• Systems and processes to reduce risks to patient and staff safety needed strengthening.
• Risks to patients and staff had not adequately been assessed, in particular those relating to staff immunity status, infection prevention and control, appropriate background checks for staff, significant events and safety alerts.

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

• Systems and processes to reduce risks to patient and staff safety were lacking.
• There was limited evidence of improvements made following our inspection in November 2018.

The areas where the provider must make improvements are:

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

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

The areas where the provider should make improvements are:

• Undertake risk assessments for any storage of hazardous substances for example, liquid nitrogen, storage of chemicals.
• Ensure all policies, procedures and protocols are regularly reviewed and appropriate for implementation.
• Maintain accurate recruitment records in line with practice policy and legislative requirements.
• Complete timely appraisals for all staff.
• Improve the support and implementation of practice managerial functions.

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

This practice is rated as Good overall. (Previous rating 10/2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Hilltops Medical Centre on 26 November 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice had some clear systems to manage risk so that safety incidents were less likely to happen. However, there were some areas that were in need of strengthening. In particular, risks in relation to infection prevention and control needed review. 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients we spoke with reported some difficulties with the appointment system and reported that they were not always able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements is:

• Ensure care and treatment is provided in a safe way to patients. (Please refer to the requirement notice section at the end of the report for more detail).

The areas where the provider should make improvements are:

• Provide appropriate non-clinical staff with training on sepsis.
• Undertake regular fire drills.
• Implement the newly developed appraisal system and complete staff appraisals for all staff in line with practice policy.
• Embed newly adopted processes for ensuring practice oversight of clinical registrations
• Continue with efforts to improve patient satisfaction and performance in the national GP patient survey; with particular regard for patient experience during consultations.
• Complete the proposed auditing of practice policies and procedures to ensure they are up to date and relevant.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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