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

Letter from the Chief Inspector of General Practice

We carried out an announced focussed inspection of Dr Richard Hattersley on 11 April 2017. This was to check compliance relating to the serious concerns found during a comprehensive inspection on 2 February 2017 which resulted in the Care Quality Commission issuing a Warning Notice with regard to Regulation 17, Good Governance.

Other areas of non-compliance found during the inspection undertaken on 2 February 2017 will be checked by us for compliance at a later date.

Following our inspection undertaken on 2 February 2017 we rated the practice as requires improvement overall. Specifically, the domains of caring and responsive were assessed as providing good services. The domains of safe and effective were rated as requires improvement and the well-led domain was rated as inadequate. The ratings for the provider will remain in place until a comprehensive inspection is undertaken.

This report covers our findings in relation to the warning notice requirements only and should be read in conjunction with the latest comprehensive inspection report for the February 2017 inspection. This can be found by selecting the ‘all reports’ link for Dr Richard Hattersley on our website at www.cqc.org.uk. The full reports for the September 2015 and May 2016 inspections can also be found here.

At this inspection in April 2017, we checked the progress the provider had made to meet the significant areas of concern as outlined in the Warning Notice dated 16 February 2017, for a breach of Regulation 17 (Good Governance). We gave the provider until 31 March 2017 to rectify these concerns about governance of the practice. The Warning Notice was issued because we found there were inadequate systems or processes to effectively reduce risks to patients and staff as follows:

• Patients were at risk of harm because systems and processes were not being followed to keep them safe. For example, not all staff had received training in safeguarding and public areas were not effectively monitored for potential risks to patients and staff.
• The practice had no clear leadership structure and limited formal governance arrangements to ensure high quality care.
• 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.
• Medicine safety alerts were not monitored to ensure they were followed through.

At our inspection on 11 April 2017 we found the provider had achieved compliance in some areas of regulation 17 as set out in the warning notice. However, there were still areas relating to the warning notice that required improvement. Our key findings were:

• There were effective systems in place to ensure learning from significant events and complaints occurred.
• Clinical audits had been commenced; these focussed on the areas of greatest risk to the practice, such as clinical workload.
• The practice had taken steps to reduce any potential health and safety risks for patients and staff.
• Patient outcomes were not closely monitored. For example, some patients with long-term conditions had not been reviewed by the practice in line with national guidance.

The other key lines of enquiry will be reassessed by us at another inspection when the provider has had sufficient time to meet the outstanding issues. At that time a new rating will be assessed for the provider. The outstanding issues that the practice must address are:

• Ensure policies reflect procedures in the practice and are readily available to staff.
• Ensure that all patients including those with long term conditions have their needs assessed and met.

In addition, the issues that the practice should address are:

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

Where a service is rated as inadequate for one of the five key questions or one of the six population groups, it will be re-inspected no longer than six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

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