The Care Quality Commission
  • Doctor
  • GP practice

Archived: North Park Health Centre

Overall: Inadequate read more about inspection ratings

290 Knowsley Road, Bootle, Merseyside, L20 5DQ

Provided and run by:
TCG Medical Services Limited

Important: The provider of this service changed. See new profile
Important: The provider of this service changed. See old profile

All Inspections

28 & 29 November 2022

During a routine inspection

We carried out an announced comprehensive inspection at North Park Health Centre on 28 & 29 November 2022. Overall, the practice is rated as inadequate.

Safe - inadequate

Effective - requires improvement

Caring - good

Responsive - inadequate

Well-led – inadequate

The full reports for previous inspections can be found by selecting the ‘all reports’ link for North Park Health Centre on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection in response to concerns reported to us about the operation of the service.

We included all key questions in the inspection, safe, effective, caring, responsive and well-led.

How we carried out the inspection:

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • 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.
  • A site visit.
  • Interviewing staff in a range of roles.
  • Receiving feedback from staff through feedback forms

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 rated the provider as Inadequate for providing safe services. This was because:

  • Safeguarding was not given sufficient priority and staff were not clear who the safeguarding leads were.
  • Staff did not undertake mandatory training until six months into their roles. In the absence of training risks assessments were not undertaken.
  • Staff recruitment records were not kept in order to comply with the regulations.
  • The arrangements for managing medicines did not always keep patients safe.
  • Learning from significant events was not always shared with relevant staff.
  • Systems for managing historical safety alerts were not always effective.
  • The provider was not effectively assessing and monitoring the clinical capacity to ensure this was sufficient to meet the needs of the patient population. The provider was not acting upon concerns about staffing levels.

We rated the provider as Requires Improvement for providing effective services. This was because:

  • Patients’ needs were assessed, but care and treatment was not always delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
  • Patients with long-term conditions were not always receiving relevant reviews that included all elements necessary in line with current best practice guidance. Patient reviews were not always followed up in a timely manner where necessary.
  • The practice carried out quality improvement activity, but there was not always evidence that they had implemented and followed up on the recommended changes.
  • Cervical cancer screening uptake was well below national averages and continued to steadily decline.

We rated the provider as Good for providing caring services. This was because;

  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • Patient feedback was generally positive about their experiences with the clinical team.

We rated the provider as Inadequate for providing responsive services. This was because;

  • Patients were not always able to access care and treatment in a timely way.
  • Patients were not able to make appointments in a way that met their needs and patients were highly dissatisfied with telephone access.
  • Feedback from patients was not being used to drive improvement.

We rated the provider as Inadequate for providing well-led services. This was because:

  • The overall governance arrangements were not fully effective.
  • There was a lack of leadership at the practice.
  • Arrangements for identifying, recording and managing risks, issues and mitigating actions were not fully effective.
  • The provider had not risk assessed the impact of the lack of GPs on site or taken actions to mitigate this.
  • Structures, processes and systems for accountability were not clearly set out or understood by staff.
  • Patient views were not acted on to improve services.
  • Statutory CQC notifications had not been submitted in line with requirements.

We found breaches of regulations. The provider must:

  • 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.
  • Assess, monitor and mitigate the risks relating to the health, safety and welfare of service users.
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment
  • Ensure recruitment procedures are established and operated effectively to ensure that specified information is available regarding each person employed.

The provider should:

  • Identify carers to ensure these patients are offered appropriate support.
  • Make information on how to make a complaint readily available to patients.
  • Ensure procedures for ‘Do not attempt’ (DNACR) are reviewed for all relevant patients.

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 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.

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

24 January 2019

During an inspection looking at part of the service

This practice is rated as Good overall. (Previous rating 5 June 2018 – Good)

The well-led key question at this inspection is rated as: Good.

We carried out an announced focused inspection at North Park Health Centre on 24 January 2019 to follow up a breach of regulation from our last inspection carried out on 5 June 2018.

The full comprehensive report on the June 2018 inspection can be found by selecting the ‘all reports’ link for North Park Health Centre on our website at .

At the previous inspection of 5 June 2018 we rated the practice as ‘good’ overall but as ‘requires improvement’ in the well-led key question. We identified a breach of Regulation 17 HSCA (RA) Regulations 2014 - Good governance. This was because the systems and processes to support good governance were not always clearly set out and there was not always sufficient leadership oversight of some of the systems and processes in place.

This inspection was a follow up inspection to confirm that the provider had carried out their plan to meet the legal requirements. Our key findings were as follows:

  • The provider had taken action to meet the breach of regulation.
  • The systems and processes in place to ensure good governance had been reviewed and improved.

We also looked at action taken in response to the recommendations we had made to the provider following the last inspection visit. We found:

  • A formalised process had been put in place to demonstrate that staff were provided with appropriate support, training, appraisal and professional development.
  • An up to date record of staff training had been produced to ensure the provider had an overview of the training staff had undergone and to identify any gaps in training.
  • A new system had been introduced to demonstrate the management of complaints and the actions taken following receipt of complaints.
  • Staff had access to regularly reviewed policies and procedures to ensure they were provided with up to date and accurate guidance to support them in their work.
  • Meetings, including clinical and governance were being recorded in greater detail to reflect the discussions and decisions made.
  • A new log for recording/accounting for blank prescriptions had been introduced.

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

Please refer to the evidence table for further information.

05/06/2018 to 05/06/2018

During a routine inspection

This practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

We carried out an announced comprehensive inspection at North Park Health Centre on 5 June 2018 as part of our inspection programme.

At this inspection we found:

  • The practice had systems in place to manage risk.
  • When safety incidents did happen, the practice learned from them and improved their processes.
  • Systems were in place to deal with medical emergencies and staff were trained in basic life support.
  • Procedures were in place to prevent and control the spread of infection.
  • There were regular checks on the environment and on equipment used.
  • Clinical audits were carried out and the results of these were used to improve outcomes for patients.
  • The practice reviewed the appropriateness of the care it provided and care and treatment was delivered according to evidence based guidelines in the areas we looked at.
  • Data showed that the practice was performing in line with local and national averages for most aspects of the care and treatment provided.
  • Staff told us they felt supported in their roles and with their professional development.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The majority of patients we received feedback from told us they had seen improvements to the appointments system and they had better access to clinicians.
  • Systems for clinical governance were not always clearly established.
  • The provider did not have sufficient leadership oversight in areas such as; support to staff, staff training and ensuring staff had access to up to date policies and procedures.

The areas where the provider must make improvements are:

  • 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:

  • Ensure formalised processes are in place to demonstrate that staff are provided with appropriate support, training, appraisal and professional development.
  • Maintain an up to date record of staff training to ensure the provider has an overview of the training staff have undergone and to identify any gaps in training.
  • Ensure appropriate systems are in place for demonstrating the actions taken following receipt of complaints.
  • Review policies, procedures and documents available to staff to ensure these provide staff with guidance that is up to date and accurate.
  • Ensure meetings, including clinical and governance meetings, are appropriately documented.

Review the arrangements for recording/accounting for prescriptions.

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