The Care Quality Commission
  • Doctor
  • GP practice

The Handbridge Medical Centre

Overall: Requires improvement read more about inspection ratings

Greenway Street, Chester, Cheshire, CH4 7JS (01244) 680169

Provided and run by:
The Handbridge Medical Centre

All Inspections

20 September 2023

During a routine inspection

We carried out an announced comprehensive inspection at The Handbridge Medical Centre on 20 September 2023. Overall, the practice is rated as requires improvement.

Safe - requires improvement

Effective – good

Caring - good

Responsive – good

Well-led - requires improvement

Following our previous inspection on 29 September 2022, the practice was rated requires improvement overall and for all key questions but caring and responsive.

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

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection.

We inspected the key questions of: 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:

  • Conducting staff interviews using video conferencing.
  • 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 short site visit.

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:

  • The provider did not have fully effective processes for assessing and managing risks associated with the premises.
  • Not all action to ensure appropriate standards of cleanliness and hygiene had been taken in a timely way.
  • The systems and processes for identifying, managing and mitigating risks to the service were not effective.

However,

  • Issues identified at the inspection in 2022 with regards staff training had been addressed.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.

We found two breaches of regulations. The provider must:

  • Ensure all premises and equipment used by the service provider is fit for use.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, the provider should:

  • Put in place a written programme of quality improvement and audits to review clinical activity over time.
  • Take action to ensure patients with long term conditions are regularly monitored.
  • Continue to monitor and improve the uptake of cervical screening and childhood vaccinations.
  • Continue to monitor patient feedback regarding access to the service and take action where this indicates improvement required.

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 Health Care

29 September 2022

During a routine inspection

We carried out an announced comprehensive inspection at The Handbridge Medical Centre on 27 and 29 September 2022. Overall, the practice is rated as requires improvement.

Safe - requires improvement

Effective - requires improvement

Caring – good

Responsive - good

Well-led - requires improvement

Following our previous inspection on 8 April 2016, the practice was rated good overall and for all key questions.

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

Why we carried out this inspection

We carried out this inspection in-line with our inspection priorities and to follow up information of concern shared with the Care Quality Commission (CQC).

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:

  • Conducting staff interviews using video conferencing.
  • 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 short site visit.

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 have rated this practice as requires improvement overall

We found that:

  • The systems and processes for identifying, managing and mitigating risk was not effective.
  • Appropriate standards of cleanliness and hygiene were not met.
  • The process to ensure the safety of the premises and equipment was not effective.
  • The practice was unable to demonstrate that all staff had the training they needed for their roles.
  • The premises were not appropriate for the service being delivered. The provider was liaising with the Integrated Care Board (formerly the Clinical Commissioning Group (CCG)) regarding the provision of new premises.

However:

  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • Patients could access care and treatment in a timely way.
  • There was a system to identify and respond to complaints.

We found two breaches of regulations. The provider must:

  • Ensure persons employed in the provision of the regulated activity receive the appropriate training to enable them to carry out their duties.

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, the provider should:

  • Take action to maintain staff vaccination records in line with current UK Health and Security Agency (UKHSA) guidance if relevant to role.
  • Consider implementing a policy for the renewal of Disclosure and Barring (DBS) checks for staff.
  • Check emergency equipment and medication weekly.
  • Monitor uncollected prescriptions at more frequent intervals and review the storage of blank prescriptions.
  • Take action to prevent the vaccine fridge being accidentally turned off.
  • Continue to take action to ensure all correspondence is available in patients electronic records in a timely manner.
  • Take steps to ensure all MHRA alerts are periodically reviewed.
  • Put in place a written programme of quality improvement and audits.
  • Take action to ensure patients with long term conditions are regularly monitored.
  • Continue to monitor and improve the uptake of breast screening, cervical screening and childhood vaccinations.
  • Record the monitoring undertaken of the referrals and consultations of staff employed in advanced clinical practice.

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

2nd February 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Handbridge Medical Centre on 2nd February 2016.

Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
  • There were systems in place to reduce risks to patient safety, for example, infection control procedures and the management of staffing levels.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.
  • Staff felt well supported. They had access to training and development opportunities and had received training appropriate to their roles.
  • Patients were very positive about the care they received from the practice. They commented that they were treated with respect and dignity and that staff were caring, supportive and helpful.
  • Services were planned and delivered to take into account the needs of different patient groups.

  • Access to the service was monitored to ensure it met the needs of patients. Patients reported satisfaction with opening hours and said they were able to get an appointment when one was needed.

  • Information about how to complain was available. There was a system in place to manage complaints.
  • There were systems in place to monitor and improve quality and identify risk.

We saw areas of outstanding practice:

  • The practice had developed and recently implemented its own autism protocol. This acted as an aide memoire to staff when booking appointments for patients with suspected or diagnosed autism and suggested reasonable adjustments to be made when attending the practice. It also stressed the importance of good communication with patients and their families or carers.

  • The practice website had a page specifically for young people which included information on common health questions, sexual health and smoking. This also provided reassurances about confidentiality which encouraged young people to visit the GP about their health concerns. The practice had also adopted the “Zoe” system after reading about how this had been implemented at another practice. This allowed a young person to make an appointment without having to go through a triage process which encouraged them to make appointments about issues they may find it difficult to talk about.

  • Following an audit a new role had been developed for a nurse in the management of coeliac disease. This was to ensure that these patients received a range of annual health checks, vaccinations and dietary advice. The nurse referred the patient to the GP if any issues were identified. A follow up coeliac audit 2015-2016 indicated that most patients were taking up their invitation to be seen annually for checks and vaccinations.

The areas where the provider should make improvements are:

  • A record should be made of which clinician printable prescriptions have been allocated to as recommended by NHS Protect.

  • A risk assessment of the storage of printable prescriptions and written patient records should be undertaken to ensure these are securely stored at all times.

  • A disability access audit of the premises should be undertaken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

4 June 2014

During a routine inspection

The Handbridge Medical Centre is located in Handbridge, in the City of Chester. It provides a range of services for all population groups across all ages. People can access advice, care and treatment by telephone consultations with doctors or nurses and book appointments online or by phone. Usual opening times are 8am to 6.30pm Monday to Friday. The practice was registered by the Care Quality Commission (CQC) in April 2013 to provide the following regulated activities:

Treatment of disease, disorder or injury

Surgical procedures

Maternity and midwifery services

Family planning

Diagnostic and screening procedures.

All the patients we spoke with were complimentary about the service they received. We saw the latest patient survey results, which showed patients were consistently pleased with the service. We received a number of comments cards that had collected the views of patients at the practice over the previous two weeks before our inspection. All the comments received were extremely positive about care, treatment and services provided by the Handbridge Medical Centre.

The practice delivered services safely. We found that safeguarding of adults and children was managed well. All staff had been trained at a level appropriate to their role and demonstrated knowledge, application and understanding of safeguarding.

The practice was effective in how it delivered care and treatment. We saw examples of good practice, including care for people aged over 75 and an award won for innovative practice in community mental health care.

The practice was responsive to the needs of its patient population. Members of the patient participation group (PPG) told us how the practice responded well and made improvements to services following suggestions, comments or complaints.

We found the practice to be extremely well-led. There was an open culture of incident reporting and learning from events and complaints to improve services. There were excellent arrangements for governance and managing risks, which ensured patients were cared for and treated safely and effectively.

The practice provided services for all population groups safely, effectively and in a caring, responsive manner. A number of services were developed for specific population groups. These were delivered effectively in line with current good practice guidelines.