Baslow Health Centre

We carried out an announced inspection at Baslow Health Centre on 23 and 31 August 2022. Overall, the practice is rated as requires improvement overall. It is rated as:

Safe: requires improvement

Effective: good

Caring: good

Responsive: good

Well-led: requires improvement

Following our previous inspection, the practice was rated Outstanding overall and for key questions caring and responsive, and good for safe, effective and well-led.

At the last inspection in June 2016 we rated the practice as outstanding for providing caring and responsive services because:

• GPs provided personalised care, especially to those patients requiring end of life care and those living in the local care home.
• The national GP survey which showed that patients rated the practice above local and national averages in respect of all aspects of care and for access.
• The practice hosted some services on site which made it easier for their patients to access them.

At this inspection, we found that those areas previously regarded as outstanding practice were now embedded throughout the majority of GP practices. While the provider had maintained this good practise, the threshold to achieve an outstanding rating had not been reached. The practice is therefore now rated good for providing caring and responsive services.

We also carried out an unrated review of the practice on 7 December 2021.

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

Why we carried out this inspection

This inspection was a comprehensive inspection to follow up on:

• The issues identified in the unrated review in December 2021.
• Key questions safe, effective, caring, responsive and well-led.
• Follow up of a Requirement Notice breach in Regulation 17 HSCA (RA) Regulations 2014 Good Governance
• Follow up on a Requirement Notice breach in Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment.
• One best practice recommendation.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider
• Reviewing patient records to identify issues and clarify actions taken by the provider
• Requesting evidence from the provider
• A site visit
• Spoke with one care home representative.

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 rated the practice as requires improvement for providing a safe service. This is because:

• The practice could not evidence that staff received Infection Prevention and Control training, either as part of their induction or through periodic refresher training.
• Not all staff were aware of the location of emergency equipment and medicines.
• There were incomplete reviews and implementation of changes for significant events.

However:

• The multidisciplinary team meetings discussed any patients deemed to be at risk or of concern, including those admitted to hospital, ready for discharge or requiring additional support in the community.
• Improvements had been made to the processes for the safe handling of requests for repeat medicines, including those for high risk medicines and controlled medicines.
• The practice generally provided care in a way that kept patients safe and protected them from avoidable harm.

We rated the practice as good for providing an effective, caring and responsive service. This was because:

We found that:

• Patients received effective care and treatment that met their needs, although care plans needed to be used more consistently by clinicians.
• The practice had strengthened the procedures in place around medicine reviews however, processes were not in place to ensure consistence use of templates and care plans.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.

We rated the practice as requires improvement for providing a well-led service. This is because:

• Some aspects of staffing continued to present challenges, inparticular maintain reception / administrative staffing levels, although the practice had successfully recruited a GP partners, two salaried GPs, and practice manager and additional reception / administrative staff.
• Structures, processes systems to support good governance and management were not always effective.
• The management of safety systems was not effective particularly in relation to staff training, employment checks and learning from significant events and complaints was not always communicated effectively or embedded into practice.
• Not all staff felt valued or supported in their roles.
• Clear and effective process for managing risks, issues and performance were not always in place.

We found three 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.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed

The provider should:

• Use a patient identification method in the multidisciplinary team meetings that clearly identifies the correct patient.
• Continue to obtain the immunisation status for all staff and take appropriate action according to the information received.
• Obtain confirmation from NHS Estates the temperature of the hot water within the practice is at the required temperature to maintain the safe control of legionella.
• Make all staff aware of the location of the emergency equipment and emergency medicines.
• Provide purple lidded waste bins to dispose of cytotoxic and hormone based medicines in the dispensary.
• Review all patient records coded as having ReSPECT forms in place to ensure the form is available in the notes.
• Consider succession planning for all teams within the practice.
• Update all staff about the mission statement, values and strategy.
• Implement nurse team meetings.

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