Archived: Dr Richard Hattersley Also known as Boscombe Manor Medical Centre

Updated 16 May 2017

Dr Richard Hattersley, known locally as Boscombe Manor Health Centre, is based in Boscombe, a suburb of Bournemouth, Dorset. It has been at its present location since 1996, and operates out of a converted Victorian era building.

The practice is part of NHS Dorset Clinical Commissioning Group (CCG) and has an NHS general medical services contract to provide health services to approximately 2,900 patients. The practice is open from 8am to 6pm from Monday to Friday. Pre bookable extended hours appointments are available between 7.30am and 8am on Mondays and Thursdays. The practice has opted out of providing out-of-hours services to their own patients and refers them to the NHS 111 service or a local out of hours service.

The number of patients aged between 25 and 45 years old is up to four times higher than the national average. The practice is based in an area of high social deprivation and life expectancy for both males and females is lower than the CCG and national averages. The practice has more than twice the national average for patient turnover. Approximately 25% of the practice population changes every year; however the number of patients registered at the practice has remained constant. A high proportion of patients at the practice, approximately 13%, are affected by serious mental illness and/or substance misuse. Approximately 16% of patients registered at the practice do not speak English as a first language, with the majority of these originating from an Eastern European background.

The practice has one GP and one salaried GP who together are equivalent to 1.3 full-time GPs. Both GPs are male. The practice has one female practice nurse, who worked half a day per week and a female health care assistant, who worked one and half days per week. At the time of our inspection, the practice was also employing a locum nurse on a regular basis to undertake a day every fortnight. The clinical team are supported by a team of two full-time reception staff.

We carried out our inspection at the practice’s only location which is situated at:

Dr Richard Hattersley

Boscombe Manor Medical Centre

40 Florence Road

Boscombe

Bournemouth

Dorset

BH5 1QH

Updated 16 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Richard Hattersley on 2 February 2017 to assess whether the practice had made the improvements in providing care and services that were safe, effective and well-led.

We had previously carried out an announced comprehensive inspection at Dr Richard Hattersley on 2 September 2015. Following the inspection in 2015, the practice was rated as requires improvement overall. The practice was rated as good for being caring and responsive and requires improvement for safe, effective and well-led. Shortfalls identified covered blank prescriptions not being safely tracked by the practice. Gaps in the employment checks necessary for staff. There was a lack of governance systems to adequately monitor patient outcomes and manage risks to patients and staff.

We carried out an announced focussed inspection at Dr Richard Hattersley on 31 May 2016 to assess whether improvements had been made. At the inspection in May 2016, the practice was able to demonstrate that they had made some improvements. However, the practice was unable to demonstrate that they were fully meeting the standards. The practice was rated as requires improvement for safe, effective and well-led services. The overall rating for the practice remained at requires improvement. We found systems for reporting and investigating significant events and emergencies were not consistently safe. Data showed that patient outcomes remained lower than local and national averages.

The reports on the September 2015 and May 2016 inspections can be found by selecting the ‘all reports’ link for Dr Richard Hattersley on our website at www.cqc.org.uk

This inspection was a further announced comprehensive inspection, to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified at previous inspections. The practice is rated as requires improvement overall.

Our key findings across the areas we inspected on 2 February 2017 were as follows:

• Patients were at risk of harm because systems and processes were not being followed to keep them safe. For example, the practice did not have assurance that infection control practice consistently followed current guidance. Not all staff had received training in safeguarding and public areas were not effectively monitored for potential risks to patients and staff.
• Staff were able to report incidents, near misses and concerns; however the practice had not ensured that all staff understood what should be reported. Learning was not consistently shared with all staff to ensure improvements to care were made.

• Data showed patient outcomes were low in some areas compared to the locality and nationally. A limited amount of clinical audits had been carried out, and there was no effective system to manage performance and improve patient outcomes. There was limited focus on prevention and early detection of the health needs of all patients.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• The practice was responsive to the needs of patients from vulnerable groups. For example, approximately 10% of the practice population had alcohol and substance misuse issues. The practice were well equipped to deal with these patients’ needs. The lead GP had undertaken an extended qualification to support patients with substance misuse.

The practice had no clear leadership structure and limited formal governance arrangements to ensure high quality care. Staff felt supported by leadership. 

The areas where the provider must make improvements are:

• Ensure that governance systems operate effectively. For example, the practice must review the system in place for reporting significant events and learning from complaints, reviewing the health and safety of the practice including infection control processes.
• Ensure that patients with long term conditions have their needs assessed and met.
• Instigate a programme of clinical audit to improve outcomes for patients.
• Ensure an effective system for the reviewing and acting upon medicines and other safety alerts.
• Ensure practice policies reflect current processes in the practice. For example, the complaints process and business continuity plan.

The areas where the provider should make improvements are:

• Review engagement with the patient participation group.
• Review the process to encourage patients to participate in screening programmes for breast and bowel cancer.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 April 2017

The provider was rated as requires improvement for people with long-term conditions. The issues identified as requires improvement overall affected all patients including this population group. There were, however, examples of good practice for caring and responsiveness.

• Outcomes for patients with long-term conditions had not improved since the last inspection. Exception reporting figures remained higher than local and national averages. For example:

• Data for patients with diabetes were comparable to national figures. For example, the percentage of patients with diabetes, on the register, who had an acceptable blood pressure reading in the preceding 12 months, was 70%, compared to a national average of 78%. However, exception reporting for this indicator was higher than average at 27%, compared to a national figure of 9%.
• A total of 96% of patients with COPD (Chronic obstructive pulmonary disease, a chronic lung condition) had a care plan agreed and documented in the notes compared to a CCG average of 92% and national average of 90%. Exception reporting for this indicator was higher than CCG and national averages at 33%.
• Longer appointments and home visits were available when needed.
• Nurses had lead roles in chronic disease management and received training to provide care in line with national guidance.
• Patients at risk of hospital admission were identified and the practice held admission avoidance meetings to ensure these patients’ needs were met.

Updated 4 April 2017

The provider was rated as requires improvement for families, children and young people. The issues identified as requires improvement overall affected all patients including this population group. There were, however, examples of good practice for caring and responsiveness.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates were mixed for childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• A total of 81% of eligible women attended for a cervical smear in 2015-2016. This is similar to the national average of 82%. However, exception reporting for this indicator was 24%, higher than the national average of 7%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice held regular meetings with other professionals to ensure the needs of this group were met. For example, joint meetings with health visitors, midwives and social workers to gain a holistic understanding of the needs of this group.

Updated 4 April 2017

The provider was rated as requires improvement for older people. The issues identified as requires improvement overall affected all patients including this population group. There were, however, examples of good practice for caring and responsiveness.

• The practice offered personalised care to meet the needs of the older patients in its population.

• Those at risk of unplanned hospital admission always received same day appointments.
• Performance indicators for conditions commonly found in older patients were comparable to national averages. For example, 100% of patients with a history of a stroke or mini-stroke, received a flu vaccine in the preceding 12 months compared to a national average of 96%. However, exception reporting for this indicator was 29% compared to a national average of 20%.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

Updated 4 April 2017

The provider was rated as requires improvement for working age people (including those recently retired and students).

• 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 offered flexible telephone appointments to meet the needs of this group.
• 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.
• Pre-bookable appointments with GPs and were available in extended hours to meet the needs of this group.
• The practice responded to the high student population in the area by offering them appropriate vaccines.

Updated 4 April 2017

The provider was rated as requires improvement for people experiencing poor mental health (including people with dementia).

• A total of 94% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher than the clinical commissioning group (CCG) average of 86% and national average of 84%. Exception reporting for this indicator was lower than CCG and national averages.
• The practice supported a high proportion of patients had alcohol or drug misuse health issues. Approximately 10% of the practice population were affected by this issue. Staff were experienced in this area, and we saw that the care of these patients was appropriate.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a care plan recorded in the preceding 12 months was 93% compared to the CCG average of 91% and national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 4 April 2017

The provider was rated as requires improvement for people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances, including those without a fixed abode.

• The practice had five patients with a learning disability. At the time of our inspection, none of these patients had been offered a health check in the previous 12 months.
• The practice offered longer appointments for patients with vulnerable circumstances.
• The practice supported patients of no fixed abode to register the practice as their place of address. The practice then forwarded relevant communication to patients to help ensure all their needs were met.
• The practice regularly 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.