The Care Quality Commission
  • Doctor
  • GP practice

Archived: Hylton Medical Group

Overall: Inadequate read more about inspection ratings

Pallion Health Centre, Sunderland, Tyne and Wear, SR4 7XF (0191) 565 8598

Provided and run by:
Hylton Medical Group

All Inspections

2 February 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of this practice on 21 April 2015. The practice was judged to be inadequate and placed in special measures. After this inspection the practice wrote to us to say what action they would take to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

  • Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.
  • Regulation 18 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Staffing.
  • Regulation 19 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Fit and proper persons employed.

On 4 February 2016 we carried out an announced comprehensive inspection at Hylton Medical Group a nd found that improvements had been made since the previous inspection of April 2015. In recognition of the improvements made the practice was rated overall as requires improvement, having being judged as requires improvement for Effective and Well Led services. The full comprehensive reports for both inspections can be found by selecting the ‘all reports’ link for Hylton Medical Group on our website at www.cqc.org.uk .

This announced comprehensive inspection was carried out on the 2 February 2017 in order to see that action had been taken by the practice to make improvements from the inspection in February 2016. Overall the practice has been rated as inadequate from this inspection as it has failed to address a number of issues identified in the previous inspection and further issues were identified.

  • Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses.
  • Risks to patients were assessed and managed.
  • Outcomes for patients who use services were improving, for example for the 2016/17 QOF year so far the practice was currently achieving 96.1% of the overall points available to them.
  • There was no programme of clinical audit to improve patient outcomes. The lead GP said clearly they were not interested in being involved in clinical audit they preferred to see patients.
  • W e were not assured that there was discussion and leadership around best practice and clinical guidelines at practice level.
  • We confirmed that staff had received training appropriate to their role. However, the practice nurses had not received any information governance training. There was no record of the lead GP carrying out information governance training​.
  • Staff were proactive in supporting patients to live healthier lives through a targeted approach to health promotion. Information was provided to patients to help them understand the care and treatment available.
  • Patients who completed comment cards said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There were mixed views from patients regarding obtaining an appointment from the comment cards completed. The practice told us they had recently improved the appointment system.
  • The practice had a system in place for handling complaints and concerns and responded quickly to any complaints.
  • We were not assured that the lead GP and registered manager were providing clinical leadership and had a comprehensive understanding of the practice.
  • The practice was aware of and complied with the requirements of the Duty of Candour regulation.

We identified regulatory breaches within the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. They are Regulation 17 Good Governance and Regulation 18 Staffing. The Care Quality Commission is unable to take enforcement action against the provider regarding these breaches as they are incorrectly registered with the Care Quality Commission. They are currently registered as a partnership but, as the previous partner left some time ago, the current provider is working as a sole provider. We have written to the provider separately about this. We have made NHS England and the Clinical Commissioning Group aware of this position.

The provider must;

  • Have the knowledge and capacity to lead effectively.
  • Ensure there is discussion and leadership around best practice and clinical guidelines at practice level.
  • Ensure there is a programme of clinical improvement initiatives.
  • Ensure there is clinical input into the practice nurses appraisals.
  • Ensure all staff receive training appropriate to their role.

The areas where the provider should make improvements are:

  • Make all staff aware of the safeguarding lead.
  • Take steps to be more proactive in identifying carers and to offer support to them.

On the basis of the ratings given to this practice at this inspection and the concerns identified at previous inspections on 21 April 2015 and 4 February 2016, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel their registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

4 February 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hylton Medical Group on 4 February 2016 Overall the practice is rated as requires improvement.Specifically, we found the practice to be requires improvement for providing effective and well-led services. The practice was rated as good for providing safe, caring and responsive services.

We previously carried out an announced comprehensive inspection of this practice on 21 April 2015. Breaches of legal requirements were found. After the comprehensive inspection the practice wrote to us to say what they would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

  • Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.
  • Regulation 18 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Staffing.
  • Regulation 19 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Fit and proper persons employed.

We found at this inspection of February 2016 that improvements had been made since the previous inspection of April 2015 when the practice had been rated as Inadequate and placed in special measures.

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

  • The practice had addressed most of the issues identified during the previous inspection and had plans in place or had made progress with a small number of others.
  • Risks to patients, such as health and safety, were assessed and well managed.
  • Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.
  • The practice could demonstrate they had carried out clinical audits. However, they did not have a planned and structured approach to identifying and carrying out clinical audits.
  • Staff had received most of the training appropriate to their roles. However, it was difficult to assess if they had all received the training appropriate to their role or when refresher training was needed.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Feedback on the ability to make routine appointments easily was mixed from patients. Patients we spoke with did not have difficulty but some of the comments on CQC comment cards indicated patients found it difficult sometimes to make an appointment.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice sought feedback from patients, which they acted on.
  • There was a leadership structure in place and staff felt supported by management.
  • We saw at this inspection that governance arrangements had improved. There were some governance arrangements which supported the delivery of the action plan and good quality care.
  • CQC registration issues in the practice had not been properly addressed for over two years by the management team. We will be writing to the practice separately on this matter.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • Carry out regular fire drills.
  • Update their recruitment policy to reflect the correct legislative procedures and follow the policy when recruiting members of staff.
  • Carry out regular staff appraisals in line with the plans in place and develop a system to ensure that staff receive the correct training appropriate to their role and refresher training.
  • Address CQC registration issues.

I am taking this service out of special measures. This recognises the improvements that have been made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

21 April 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hylton Medical Group on 21 April 2015. Overall, the practice is rated as inadequate. Specifically, we found the practice to be inadequate for providing ‘safe’, 'effective' and ‘well-led’ services, requires improvement for providing ‘caring’ services, and good for providing ‘responsive’ services. There were aspects of the practice which were ‘inadequate’ and this affected all of the population groups.

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

  • The provider had not complied with their conditions of registration which meant it was not clear who was legally accountable for carrying on the day-to-day regulated activities for which the partnership was registered;
  • Whilst the GP partners were working hard to meet patients’ needs, the difficulties experienced during the previous 12 months recruiting a second GP partner had led to a significant high usage of GP locums. At times, this had had a detrimental impact on continuity of care patients received;
  • We were unable to confirm that patients’ needs were assessed and care planned and delivered in line with current legislation and best practice guidance, because there was no system in place for reviewing and, where necessary, updating the practice’s clinical guidelines in light of changes to national and local CCG guidelines. Also, clinical staff had not carried out a structured programme of clinical audits and, they did not engage with other local practices in benchmarking their performance;
  • Most patients told us they were treated well and received a good service. Findings from the National GP Patient Survey for the practice showed that the levels of patient satisfaction were, for most areas covered by the survey, lower than the local Clinical Commissioning Group (CCG) and national averages;
  • The practice had not carried out the required pre-employment recruitment checks on all new partners and staff to make sure they were suitable to work with vulnerable children and adults;
  • There was a system in place for identifying, reporting on and learning from significant events. However, the quality of the recording of significant events was not satisfactory and did not always demonstrate the steps taken by the practice to safeguard patients and prevent their reoccurrence;
  • The practice was clean and hygienic throughout, and patients were satisfied with the levels of cleanliness;
  • The practice had good facilities and was well equipped to treat patients and meet their needs. However, the arrangements for keeping patients’ medical records secure at all times were not effective;
  • The practice did not have a clear strategy and vision for the future which was understood and shared by all the partners and staff.

The areas where the provider must make improvements are:

  • Ensure adequate GP cover is maintained at all times to meet the needs of patients and avoid the cancelling of patient appointments;
  • Ensure staff are appropriately supported to carry out their roles and responsibilities. In particular, ensure all staff receive regular supervision and appraisals;
  • Carry out the required pre-employment checks for new partners and staff;
  • Ensure suitable arrangements are in place to assess, monitor and improve the quality and safety of the services provided. In particular, undertake clinical audits to demonstrate improvements in patient care and, review and update clinical guidelines to ensure patients receive the most effective care and treatment available;
  • Ensure all clinical staff receive training in the use of the Mental Capacity Act (2005).

The areas where the provider should make improvements are:

  • The practice should seek appropriate assurances from NHS England that a DBS check has been undertaken and keep a record of the outcome;
  • Ensure non-clinical staff who carry out chaperone duties undergo a Disclosure and Barring Service (DBS) check. Carry out a risk assessment to determine which staff roles require a DBS check;
  • Make sure an effective system is in place for dealing with safety alerts in the absence of the practice manager;
  • Take account of the advice contained in the Significant Event Analysis GP Mythbuster which can be found on the Care Quality Commission's website;
  • Ensure patients’ paper medical records are kept secure at all times;
  • Update the practice’s business continuity plan, and ensure all staff are aware of its content and their roles and responsibilities in relation to it;
  • Ensure all staff who carry out lead clinical roles receive clear guidance about their responsibilities and how they should implement these;
  • Carry out a recorded risk assessment to determine which emergency medicines the GPs should carry with them during routine visits for use in an acute situation. When doing this, take account of the guidance issued by the CQC;
  • Develop a clear shared strategy that takes account of the views and contributions of partners and staff.

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 vary the provider’s registration 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