Archived: Hillside Bridge Surgery

We carried out an announced comprehensive inspection at Hillside Bridge Surgery on 3 July 2018. The overall rating for the practice was inadequate and the service was placed in special measures. The full comprehensive report for the July 2018 inspection can be found by selecting the ‘all reports’ link for Hillside Bridge Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 19 September 2018 to confirm that the practice had responded to the warning notice dated 24 July 2018 and met the legal requirements in relation to the breach of Regulation 12 (1), Safe Care and Treatment, identified in our previous inspection on 3 July 2018. The practice was required to be compliant with the concerns documented in the warning notice by 1 September 2018.

This report covers our findings in relation to those requirements.

Our key findings were as follows:

• We found a number of areas where the practice was not compliant with regulation 12 as was required.
• The provider had taken steps to improve the management of medicines in the practice. However, we identified a number of further concerns in this area which needed improvement.
• The provider had reviewed their approach to the management of significant events. We saw that recent events had been reviewed, managed and discussed at staff meetings. We saw evidence that changes were made as a result of the event.
• A process to manage the appropriate use, distribution and storage of prescription pads had been introduced but did not fully meet NHS Protect guidance.
• The system in place to manage the administration of medicines under patients group directions (PGDs) did not meet standards and had not improved. We asked the provide to review this with immediate effect.
• The practice had requested DBS checks for five member of staff who had been transferred from the previous provider; only one of these checks had been returned on the day of our inspection. We asked the provider to further review this to ensure that patients were safe.
• The provider had reviewed their approach to the management of infection prevention and control in the practice. However, a number of related issues had yet to be addressed and additional concerns were found on the day of inspection.

Importantly, the areas where the provider must make improvements as they are in breach of regulations are:

• The provider must ensure that safe care and treatment is provided in a safe way to patients.

We are taking further action in line with our enforcement processes. The service will be kept under review and if needed could be escalated to urgent enforcement action.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as Inadequate overall.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires Improvement

Are services responsive? – Inadequate

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection of Hillside Bridge Surgery on 03 July 2018. The current provider, Dr Poonam Jha, registered the location with the CQC in October 2017 after taking over the management of the surgery on 01 June 2017. There was some continuity of staffing between the previous and current provider.

At this inspection we found:

• The practice did not have appropriate systems in place to manage risk so that safety incidents were less likely to happen. When incidents did happen, we saw that significant events forms were incomplete and there was limited written evidence of dissemination to staff, learning from these incidents or changes in policies or procedures.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Feedback from six of the eight patients we spoke with on the day of inspection emphasised concerns regarding the practice and specifically the unhelpful and negative attitude of some staff members. A number of patient comment cards also reflected these concerns; as well as highlighting issues relating to accessing appointments and contacting the practice. One patient told us they were frightened to ring the practice.
• The practice did not have reliable systems for the appropriate and safe handling of medicines.
• The practice could not provide evidence of DBS checks for five staff who had worked for the previous provider; this included a GP and a nurse. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.)
• Not all staff at the practice had received up to date training. This included child and adult safeguarding training and infection prevention and control.

The areas where the provider must make improvements as they are in breach of regulations are:

• The provider must ensure that safe care and treatment is provided in a safe way to patients.
• The provider must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Continue to review and improve the identification of carers to enable this group of patients to access the care and support they may require.
• Review and improve their approach to the management of infection prevention and control within the practice.
• Continue to review and improve the uptake of cancer screening at the practice.
• Improve the approach to auditing infection prevention and control in the practice to ensure that all areas of the practice are reviewed.

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 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