The Care Quality Commission
  • Doctor
  • Out of hours GP service

Heartbeat Alliance

Overall: Requires improvement read more about inspection ratings

Mowbray House Surgery, Malpas Road, Northallerton, North Yorkshire, DL7 8FW

Provided and run by:
Heartbeat Primary Care Community Interest Company

All Inspections

17 & 18 May 2023

During an inspection looking at part of the service

We carried out an announced comprehensive inspection of the extended access service run by Heartbeat Primary Care Community Interest Company at various sites across Hambleton, Richmondshire and Whitby from 17 to 18 May 2023. Overall, the provider is rated as requires improvement.

Safe - Requires improvement

Effective – Good

Caring – Not inspected, rating of good carried forward from previous inspection

Responsive - Good

Well-led – Requires improvement

Why we carried out this inspection

We carried out an announced focused inspection at Heartbeat Alliance to follow up on breaches of regulation identified at our previous inspection. At the last comprehensive inspection in May 2022, we rated the practice as requires improvement overall, requires improvement for safe and effective, good for caring and responsive and inadequate for well-led. This was because the provider:

  • did not ensure that care and treatment was always delivered in a safe way for patients
  • did not ensure persons employed in the provision of the regulated activity received the appropriate support, training, professional development, supervision, and appraisal necessary to enable them to carry out their duties
  • did not ensure effective systems and processes were in place to ensure good governance in accordance with the fundamental standards of care

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 via face to face, video conferencing and requesting feedback from staff electronically
  • requesting evidence from the provider
  • reviewing patient records to identify issues and clarify actions taken by the provider
  • a site visit to the head office and two sites where the service is delivered from

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, staff, and other organisations.

We have rated this provider as requires improvement overall.

We found that

  • At our last inspection in May 2022, we rated the provider as requires improvement for providing a safe service. This was because there was a lack of oversight in respect of recruitment, training, equipment and premises, significant events, patient safety and alerts, prescription security, business continuity planning; and the ability to respond to a medical emergency. At this inspection we found improvement in some but not all of the above areas. Some areas had been addressed such as access to emergency equipment, prescription security and security alerts for example. However, many of the changes had only recently been introduced and not fully embedded/implemented.
  • At our last inspection in May 2022, we rated the provider as requires improvement for providing an effective service. This was because we identified concerns relating to quality improvement, including clinical and prescribing audit and the arrangements for ensuring staff had the skills, knowledge, and experience to carry out their roles. At this inspection we found improvement in all areas.
  • We rated the service as good for providing responsive services at the last inspection. We continued to rate the service as good for providing responsive services.
  • At our last inspection in May 2022, we rated the provider as inadequate for providing a well-led service as systems and processes to demonstrate effective oversight and good governance were not in place. At this inspection we found improvement in terms of the day-to-day management of the enhanced service. However. we found the continued lack of capacity at management and executive level to be able to fully embed and support the changes that were being introduced/needed.

The area where the provider must make improvement is:

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

3, 5 and 6 May 2022

During a routine inspection

We carried out an announced comprehensive inspection of the extended access service run by Heartbeat Primary Care Community Interest Company at various sites across Hambleton, Richmondshire and Whitby from 3 to 6 May 2022. Overall, the provider is rated as requires improvement.

Safe - Requires improvement

Effective – Requires improvement

Caring - Good

Responsive - Good

Well-led – Inadequate

Why we carried out this inspection

This announced comprehensive inspection was the provider’s first inspection. We looked at the key questions of safe, effective, caring, responsive and well-led.

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 via face to face and video conferencing;
  • requesting feedback from staff electronically;
  • requesting evidence from the provider;
  • reviewing patient records to identify issues and clarify actions taken by the provider; and
  • a site visit to the head office and two sites where the service is delivered from.

As part of this inspection we received feedback via face to face interview, video conference interview, discussions with staff working on-site and electronic questionnaire. This feedback came from members of the management team, clinical and non-clinical staff.

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, staff and other organisations.

We have rated this provider as requires improvement overall.

We found that:

  • the provider was open and transparent about the challenges of the past year. The service had stepped-up during the pandemic to provide services and contribute to the local health agenda and work in partnership with stakeholders to deliver patient care during this time. For example, setting up COVID-19 ‘hot hub’ sites where patients with suspected COVID-19 could be seen and the delivery of the COVID-19 vaccination programme;
  • there were gaps in systems to assess, monitor and manage risks to patient safety. The provider could not demonstrate fully developed safety systems were in place;
  • the provider had undertaken some quality improvement activity, including clinical audit to monitor outcomes of care and treatment;
  • the provider could not demonstrate effective systems and processes to ensure that staff had the skills, knowledge and experience to carry out their roles;
  • staff worked together and with other health and social care professionals to deliver effective care and treatment;
  • as an extended access service, the provider was not able to provide continuity of care to support patients to live healthier lives in the way that a GP practice would. Despite this the provider demonstrated their commitment to patient education and promotion of health and well-being advice;
  • we observed staff treating patients with kindness, dignity and respect;
  • the provider organised, considered and delivered services to meet patients’ needs. Patients could access services in a timely way;
  • we found that there was a lack of oversight in key areas relating to monitoring and management of risk to patient safety and gaps in governance structures all of which had the ability to compromise the quality of care provided by the service; and
  • leaders could not demonstrate they had the capacity and skills to deliver high-quality, sustainable care.

The areas where the provider must make improvements are:

  • ensure that care and treatment was always delivered in a safe way for patients;
  • ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties; and
  • establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care