Archived: Heaton Norris Health Centre 2

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