We carried out an announced comprehensive inspection at Market Hill 8 – 8 Surgery on 22 June 2017. The overall rating for the practice was inadequate and the practice was placed into special measures. Services placed in special measures are routinely inspected again within six months. The full comprehensive report for the June 2017 inspection can be found by selecting the ‘all reports’ link for Market Hill 8 – 8 Surgery on our website at www.cqc.org.uk.
This inspection was an announced comprehensive carried out on 27 February 2018 to check whether the provider was now meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. This inspection looked at the five key questions of safe, effective, caring, responsive and well led.
This practice is rated as Requires Improvement overall. (Previous inspection June 2017 – Inadequate)
The key questions are rated as:
Are services safe? – Requires improvement
Are services effective? – Requires improvement
Are services caring? – Requires improvement
Are services responsive? – Requires improvement
Are services well-led? – Requires improvement
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Requires improvement
People with long-term conditions – Requires improvement
Families, children and young people – Requires improvement
Working age people (including those recently retired and students – Requires improvement
People whose circumstances may make them vulnerable – Requires improvement
People experiencing poor mental health (including people with dementia) – Requires improvement
At this inspection we found:
- Systems, processes and practices were mostly in place to keep patients safe.
- Performance data overall was below the local CCG and England average. There were examples where uptake for screening programmes was below local and national averages.
- The practice had a comprehensive programme of quality improvement activity and had begun to routinely review the effectiveness and appropriateness of the care provided.
- Practice staff worked with a range of health and care professionals in the delivery of patient care and was proactive in identifying opportunities to promote and support patients to lead healthier lives. For example partnership working with a local school.
- Staff told us they were committed to treating patients with compassion, kindness, dignity and respect. Recent evidence was mostly positive in respect of the way patients were treated. However, the national patient survey results remained lower than average.
- Patient feedback was mostly positive about the ease of obtaining an appointment. However results from the national GP patient survey published in July 2017 showed that patient’s satisfaction to questions on how they could access care and treatment was significantly below local CCG and national averages in five out of the six questions asked. The practice was aware of the need to review timely access to clinical staff and had begun to take action to review and address this.
- New practice management and lead Director roles had been put in place. The result of this had started to show improved outcomes for patients and staff.
- Many of the changes introduced as part of the practice improvement plan and CQC action plan were in their infancy but showing signs of clear improvement. Quality improvement was high on the agenda for the practice and systems and plans were in place to deliver further improvement and address areas that still required improvement.
The areas where the provider should make improvements are:
Ensure that staff fully understand their role in reporting safety incidents and that all incidents are reviewed appropriately.
Review the current arrangements for ensuring safety alerts are received by the practice and that the system provides assurance they are responded to appropriately.
Review the arrangement currently in place for ensuring patients aged over 75 years of age are offered an annual health check.
Review the approach to screening programmes that are below local and national averages with the aim of improving uptake and coverage.
Have in place a system to assess the prescribing competence of the practice nurse prescriber.
Review the system that identifies patients who are also carers to help ensure that all patients on the practice list who are carers are offered relevant support if appropriate.
The practice should ensure that the new governance arrangements in place are embedded into practice so that improvement is sustained and further improvement/risk is identified and addressed.
I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice