Archived: Heaton Norris Health Centre 2

Updated 25 May 2017

This inspection was an announced follow up comprehensive inspection to check whether the provider had taken action to improve the areas we identified, including two breaches of regulation at the previous comprehensive inspection undertaken on 4 August 2016. The practice was rated overall as requires improvement. The full comprehensive report on the 4 August 2016 inspection can be found by selecting the ‘all reports’ link for Heaton Norris Health Centre 2 on our website at www.cqc.org.uk.

Heaton Norris Health Centre 2 is located within a Heaton Norris Health Centre, on Cheviot Close, in Heaton Norris, Stockport. Another GP practice is also located within the health centre and other health care services are available in the building including podiatry, district nurses, health visitors and physiotherapy.

Heaton Norris Health Centre 2 is part of the NHS Stockport Clinical Commissioning Group (CCG). Services are provided under a general medical service (GMS) contract with NHS England. The practice has approximately 1520 patients on their register. The practice is a partnership between two GPs.

The practice provides two GP consultation rooms and a practice nurse treatment room. The health centre building is managed by NHS Property Services and provides patient services on the ground floor with facilities to assist and support people with disabilities. There is an independent pharmacy within the health centre. A small car park is available to the rear of the building with additional community parking available nearby.

Information published by Public Health England rates the level of deprivation within the practice population group as three on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Both male and female life expectancy at 77 years and 81 years respectively is below both the CCG and England average of 79 years (male) and 83 years (female).

The practice patient profile for 2016 indicates that the percentage of patients under 18 years of age is slightly lower at 16% than the local and national averages of 21%, although the percentage of young patients up to the age of four years is 5%, which reflects the local and national averages of 6%. The practice has a higher percentage (24%) of patients over the age of 65 years when compared to the local average of 19% and national average of 17%.

Both GP partners (one male and one female) work part time to provide the equivalent of one full time GP. The practice employs a practice manager and two reception/ secretarial staff. The practice had tried to recruit a practice nurse, and had recently employed an agency practice nurse for one full day per week, although this had been increased the week before our inspection to two full days per week. The practice also employs a health care assistant on a locum basis on Monday morning for four hours. The practice also used regularly (until recently) a locum assistant practitioner (advanced health care assistant) for four hours on a Friday morning.

The practice reception is open from 8am until 6.30pm Monday to Friday. GP consultation sessions are available Monday, Tuesday and Friday mornings and afternoons. GP consultations are also offered on Wednesday and Thursday mornings, however on the afternoons of both these days the practice telephone lines divert patients to the local out of hour’s provider, Mastercall. Evening appointments are provided once a week until 7pm on alternate Tuesday and Fridays. The practice is also open one Saturday morning each month.

When the practice is closed patients are asked to contact NHS 111 for Out of Hours GP care.

The practice provides online access that allows patients to book appointments and order prescriptions.

Updated 25 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Heaton Norris Health Centre 2 on 4 August 2016. The practice was rated as requires improvement for four key questions (Safe, Effective, Responsive and Well Led). This resulted in an overall rating of requires improvement. The full comprehensive report on the 4 August 2016 inspection can be found by selecting the ‘all reports’ link for Heaton Norris Health Centre 2 on our website at www.cqc.org.uk.

This inspection was undertaken following the receipt of an action plan that confirmed the practice would meet the regulatory requirements previously identified by 30 November 2016.

At the beginning of December 2016 the practice provided additional information in order to demonstrate the improvements they were making.

This inspection was an announced comprehensive inspection on 22 February 2017.

Overall the practice is now rated as inadequate.

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

• There was a system in place for reporting and recording significant events. At this inspection recorded evidence in the form of team meeting minutes demonstrated that staff were kept informed of the outcome of significant event investigations.
• We noted since the last inspection that recruitment checks had improved so that appropriate recruitment records, including Disclosure and Barring Service checks (DBS) for staff employed at the practice were in place. However we observed that one employee’s recruitment file was missing references.
• Some risks to patients were assessed, however the practice could not demonstrate that they had done all that was reasonably practicable to ensure patients with chronic health conditions were reviewed and assessed.
• Quality and Outcomes Framework (QOF) data for 2015/16 showed performance indicators for some patient outcomes were below the local and national average. Unverified data for the partial year from April 2016 to 22 February 2017 did not assure us that the practice performance had improved in reviewing patients with long term conditions. A recorded action plan to monitor and review the practice performance was not available.
• At the last inspection we found records of mandatory training were available for some staff but training records were not consistently maintained for the practice nurse and health care assistants employed at the practice. At this inspection training records for staff including clinical staff were available.
• The practice had good facilities and was equipped to treat patients and meet their needs. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Some patient feedback informed us that getting a routine appointment usually required at least a two week wait and it was on occasion difficult to get an urgent appointment.
• Information about services and how to complain was available and easy to understand but where similar concerns had been expressed by patients, no action had been taken to minimise reoccurrence.
• Governance arrangements to monitor and review the service provided were not supported by clear objectives and actions plans. This had resulted in gaps in service delivery and performance.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Implement action to mitigate any risks to patients and to ensure care and treatment is provided in a safe way.
• Implement comprehensive systems of governance to monitor and review the practice performance and implement strategies to improve, including:
  • Analysing significant events and patients verbal complaints to identify themes and take action to mitigate risk of reoccurrence.
  • Implementing a system to track and monitor the receipt and use of prescription paper.
  • Undertaking regular infection control audits.
  • Providing planned and recorded support to the practice manager with regular meetings and appraisal.

In addition the provider should:

• Improve monitoring of receipt of all the necessary pre-employment checks for all staff including obtaining professional and character references.
• Improve communication networks with external health care professionals.
• Review the availability of of non-urgent appointments.
• Continue efforts to identify patients who have caring responsibilities.
• Continue to try to recruit patients to establish a Patient Participation Group (PPG).

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

Updated 25 May 2017

The provider was rated as inadequate for two key questions effective, and well-led and requires improvement for providing safe and responsive services. The concerns identified overall affected all patients including this population group.

• Quality and Outcomes Framework (QOF) date for 2015/16 showed that the registered provider performed poorly when compared to the local and national averages. Unverified data for 2016/17, the partial year (April 2016 to 22 February 2017) did not show significant improvements.

For example:

• The record of diabetic patients with a blood pressure reading 140/80mmHG or less recorded within the preceding 12 months was 52%, compared to the Clinical Commissioning Group (CCG) average of 81% and the England average of 78%. Unverified QOF data for this indicator for the partial year from 1 April 2016 to 22 February 2017 showed the practice’s achievement as 48%.
• 28% of patients with diabetes registered at the practice received a diabetic foot check compared with the CCG average and the England average of 88%. Unverified QOF data for this indicator for the partial year from 1 April 2016 to 22 February 2017 showed the practice’s achievement as 38%.
• Longer appointments and home visits were available when needed.

Updated 25 May 2017

The provider was rated as inadequate for two key questions effective, and well-led and requires improvement for providing safe and responsive services. The concerns identified overall affected all patients including this population group.

• Quality and Outcomes Framework (QOF) date for 2015/16 and unverified data for 2016/17 showed a deterioration in performance when compared to the local and national averages.

For example:

• 73% of patients with asthma, on the register had an asthma review in the preceding 12 months, which compared to the Clinical Commissioning Group (CCG) and England average of 75%. However unverified QOF data for this indicator for the partial year from 1 April 2016 to 22 February 2017 showed the practice’s achievement to have deteriorated at 34%.
• Childhood immunisation rates for the vaccinations given were also below the CCG averages. Data available for 2015/16 showed deterioration in achievement when compared to data in 2014/15.
• The children’s surveillance team were supporting the practice. They confirmed that data for 2015/16 children’s immunisations and vaccinations was low. They identified that the lack of suitably qualified staff resulted in parents not being able to make appointments for their children
• Data for 2015/16 showed that the practice performed similarly to the CCG and England average for the percentage of women aged 25-64 who had received a cervical screening test in the preceding five years with 81% compared to 82% for the respective benchmarks.

Updated 25 May 2017

The provider was rated as inadequate for two key questions effective, and well-led and requires improvement for providing safe and responsive services. The concerns identified overall affected all patients including this population group.

• Quality and Outcomes Framework (QOF) date for 2015/16 and unverified data for 2016/17 showed a deterioration in performance when compared to the local and national averages.

For example: 

• 2015/16: 96% of patients with COPD (chronic obstructive pulmonary disease) had a review undertaken including an assessment of breathlessness using the medical research council dyspnoea scale in the preceding 12 months, which was better that the Clinical Commissioning Group (CCG) average of 91% and the England average of 90%. However unverified QOF data for this indicator for the partial year from 1 April 2016 to 22 February 2017 showed the practice’s achievement to have deteriorated at 78%.
• Members of the primary care engagement team also attended the practice to support them with their flu campaign in the autumn of 2016. The primary care team initiated this support because the practice had had a low uptake of the flu vaccine and Public Health England were concerned for patients’ health. The practice advised us after the inspection that they have a health care assistant employed who is trained to administer flu vaccinations.
• Gold Standard Framework (GSF) or palliative care meetings were held approximately every two to three months, and community health care professionals attended these.

Updated 25 May 2017

The provider was rated as inadequate for two key questions effective, and well-led and requires improvement for providing safe and responsive services. The concerns identified overall affected all patients including this population group.

However:

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• Extended hours appointments were available for those patients unable to attend appointments during normal working hours.

Updated 25 May 2017

The provider was rated as inadequate for two key questions effective, and well-led and requires improvement for providing safe and responsive services. The concerns identified overall affected all patients including this population group.

However:

• Data from 2015/16 showed that 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than the CCG average of 85% and the England average of 84%.Unverified QOF data for this indicator for the partial year from 1 April 2016 to 22 February 2017 showed the practice’s achievement as 100%.
• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the preceding 12 months, which was better than the local and the England average.
• The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• Patients with a diagnosis of dementia had annual reviews and care plans were recorded.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 25 May 2017

The provider was rated as inadequate for two key questions effective, and well-led and requires improvement for providing safe and responsive services. The concerns identified overall affected all patients including this population group.

However:

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments for patients who were vulnerable or with a learning disability.
• The practice worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.