The Care Quality Commission
  • Doctor
  • GP practice

The Practice Bowling Green Street

Overall: Good read more about inspection ratings

29-31 Bowling Green Street, Leicester, Leicestershire, LE1 6AS (0116) 204 7240

Provided and run by:
DHU Health Care C.I.C.

Important: The provider of this service changed. See old profile

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about The Practice Bowling Green Street on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about The Practice Bowling Green Street, you can give feedback on this service.

23 and 29 June 2022

During an inspection looking at part of the service

We carried out an announced focused inspection at The Practice Bowling Green Street. We carried out our remote searches on 23 June 2022 and an onsite visit on 29 June 2022. Following our review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions: safe, effective and well-led. Due to assurances we received from our review of information, we carried forward the ratings for the following key questions: caring and responsive from our last inspection in December 2019. Overall, the practice is rated as good. It is rated as good in safe, effective, caring, responsive and well-led.

Following our previous inspection on 11 December 2020, the practice was rated requires improvement overall and for the key questions safe and effective. It was rated good for key questions caring, responsive and well-led.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Practice Bowling Green Street on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a focused follow-up inspection to follow up on:

  • The safe, effective and well-led key questions
  • Areas identified for improvement at the last inspection:
  • Some patients’ records were not correctly coded.
  • Not all patient records were updated in the practice system to provide assurance that appropriate monitoring was in place when blood tests were completed at hospital or elsewhere.
  • Medicine reviews had not been completed for all patients.
  • Screening figures of patients for cancer were lower than average for the practice population.
  • Not all patients who would benefit from a care plan had one in place, and those that had were minimal in detail.
  • Ratings carried forward from previous inspection which included the caring and responsive domains.

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.

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.
  • information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall

We found that:

  • Staff told us they felt supported and valued in their work. Operational support for the practice had been strengthened and was welcomed by the practice staff.
  • The provider understood the strengths and challenges relating to the quality and future of services.
  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • Processes were in place to ensure high risk medicines were prescribed safely based on the the results of required blood tests.
  • Medicine reviews were prioritised for those patients who were on controlled drugs, polypharmacy (multiple medicines) and high risk medicines.
  • Improvements had been made to coding of patient notes and care plans were more detailed.
  • Staff had the skills, knowledge and experience to carry out their roles. There was a system in place to monitor compliance with staff training. Staff were encouraged and supported to develop their skills and knowledge.
  • Systems were in place to assure the provider of the competency of staff working in advanced roles.
  • 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.
  • The practice was supported by the wider organisation, and staff were clear about the roles and responsibilities within the organisational structure.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

  • Check that abnormal pathology results are viewed within 48 hours of receipt to reduce the risk of not following up patients and arranging repeat tests promptly.
  • Review patients issued steroids for an asthma exacerbation within one week as per National Institute for Health and Care (NICE) guidance.
  • Check the records of patients with potential missed chronic kidney disease (CKD) to correct any coding issues and ensure that all required monitoring checks are done.
  • Provide patients with an updated mental health care plan.
  • Continue to promote and drive the uptake of childhood immunisations and the national cancer screening programme with patients.
  • Improve staff awareness of the range of events and occurrences that must be reported to the Care Quality Commission (CQC).
  • Continue to promote and develop the patient participation group.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

11 December 2020

During a routine inspection

Overall summary

We carried out a comprehensive inspection at The Practice Bowling Street on 11 December 2020. Due to the impact of the COVID-19 pandemic, the majority of evidence reviewed, and staff interviews were undertaken remotely in advance of the site visit on 11 December.

The practice had previously received a comprehensive inspection in July 2019 when it received an overall rating of inadequate. The safe, effective and well-led domains were rated as inadequate, the caring and responsive domain were rated as requires improvement. All population groups were rated as requires improvement. The practice was placed in special measures and a warning notice was also issued against the provider.

You can read the comprehensive inspection reports by selecting the 'all reports' link for The Practice Bowling Street on our website at www.cqc.org.uk

Following our inspection in December 2020, the practice is now rated as requires improvement overall. The practice is also rated as good for providing caring, responsive and well-led services and requires improvement for safe and effective services. Population groups were rated as requires improvement for people with long term conditions, Families children and young people, Working age people, People whose circumstances make them vulnerable, and People experiencing poor mental health (including people with dementia) and good for older people within the effective domain. All population groups were rated as good in the responsive domain.

The service is now rated as requires improvement for providing safe services because:

  • The practice had made significant improvements since the previous inspection however there were still systems which needed to be embedded to ensure care delivered to patients was always safe. At this inspection we found not all patients records were coded correctly and there was not assurance when blood tests were completed in hospital or elsewhere for those patients whose medicines required monitoring.

The service is now rated as requires improvement for providing effective services because:

  • During the inspection we found systems had been established to provide effective care for patients. However, when we reviewed patients care we found some systems were not yet effective in ensuring reviews and decisions were regular and consistent. The practice was aware of this and taking steps to improve.

The service is now rated as good for providing caring services because:

  • Staff treated patients with kindness and respect and involved them in decisions about their care. Patients were positive regarding the quality of care they received from practice staff which was shown in the latest survey results.

The service is now rated as good for providing responsive services because:

  • The practice organised services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • In the early stages of the pandemic the practice adopted a total triage of all patients and a majority received their consultations by video or phone, with face to face appointments reserved for patients who would benefit from them. This was supported by DHU Health Care CIC, an organisation who have extensive experience in remote consultations, with additional staff and expertise. At the time of the inspection the consultations were still predominantly managed remotely following a triage completed by a clinician, however there was availability for same day appointments if required.

The service is now rated as good for providing well-led services because:

  • Changes to the leadership in the practice had meant staff had received the support and capacity to improve the quality of care delivered to patients. Although this had coincided with the pandemic staff told us they had been supported throughout and felt the way in which care was delivered would continue to improve.
  • The way the practice was led and managed promoted the delivery of high-quality person-centred care.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

17 Jul to 17 Jul 2019

During a routine inspection

We carried out an announced comprehensive inspection at The Practice Bowling Green Street on 17 July 2019 as part of our inspection programme. At this inspection we followed up on breaches of regulations identified at a previous comprehensive inspection on 11 December 2018 and to check if sufficient improvements had been made.

We previously carried out a comprehensive inspection at The Practice Bowling Green Street in December 2018. The practice was placed into special measures as we found:

  • The practice did not always have clear systems, practices and processes to keep people safe.
  • The oversight and governance arrangements for the management and performance of the practice were ineffective.
  • The practice did not always act on appropriate and accurate information.

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.

The practice is part of a joint venture between DHU Health Care and Leicester City Healthcare Federation which provides support with finance, governance and human resources. At this inspection, we found the provider failed to provide the necessary oversight and support to the practice.

We have rated this practice as inadequate overall.


We rated the practice as inadequate for providing safe services because:

  • Recruitment checks were not carried out in accordance with regulations.
  • The practice did not have clear systems, practices and processes to keep people safe and safeguarded from abuse.
  • Safety alerts were not shared with all relevant staff.
  • Although all staff were more involved in the significant event process, further improvements were required.
  • There were gaps in systems to assess, monitor and manage risks to patient safety.

We rated the practice as inadequate for providing effective services because:

  • Staff had not completed mandatory training essential to their role.
  • The practice did not have regular multidisciplinary meetings to enable care to be delivered in a coordinated way.
  • Verified quality and outcomes data levels were below local and national averages.
  • The practice was unable to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
  • Staff did not work together and with other organisations to deliver effective care and treatment.

We rated the practice as inadequate for providing well-led services because:

  • Leaders could not show they had the capacity and skills to deliver high quality, sustainable care.
  • The overall governance arrangements were ineffective.
  • The practice did not have clear and effective processes for managing risks, issues and performance.
  • The practice did not always act on appropriate and accurate information.
  • The practice culture did not effectively support high quality sustainable care.
  • When considering service developments or changes, the impact on quality and sustainability was assessed.

These areas affected all population groups so we rated all population groups as inadequate.

We rated the practice as requires improvement for providing caring services because:

  • Patient satisfaction surveys had not been utilised to drive improvement.
  • The majority of patient feedback was positive about staff and the service provided.
  • Staff did not always treat patients with kindness, respect and compassion.

We rated the practice as requires improvement for providing responsive services because:

  • Staff interviewed did not always have a good understanding of how to support patients with mental health needs.
  • Patients fed back they were not always able to access care and treatment in a timely way as they were not able to get through to the practice by telephone.
  • Although the provider was aware of negative feedback from different sources about difficulties getting through to the practice by telephone, insufficient action had been taken.

The areas where the provider must make improvements are:

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

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Review carer numbers to ensure all carers are identified

This service is to remain in special measures as insufficient improvements have been made. 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.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

11 Dec 2018

During a routine inspection

We carried out an announced comprehensive inspection at The Practice Bowling Green Street on 11 December 2018 as part of our inspection programme for new registrations.

The practice was taken over by DHU Health Care in February 2018.

We base 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 Inadequate overall.

We rated the practice as Inadequate for providing safe services because:

  • The practice did not always have clear systems, practices and processes to keep people safe.
  • There were some gaps in systems to assess, monitor and manage risks to patient safety.
  • The practice did not have systems for the appropriate and safe use of medicines.
  • The practice did not have a system to learn and make improvements when things went wrong.

We rated the practice as Requires Improvement for providing effective services because:

  • Patients care and treatment was not always delivered in line with current standards.
  • There was limited monitoring of the outcomes of care and treatment.
  • The practice was unable to demonstrate that all staff had the skills, knowledge and experience to carry out their roles.

We rated the practice as Requires Improvement for providing caring services because:

  • The practice did not carry out any patient feedback exercises.
  • The practice did not have a system to support carers.

We rated the practice as Requires Improvement for providing responsive services because:

  • People were not always able to access care and treatment in a timely way.
  • Complaints were not used to improve the quality of care.

We rated the practice as Inadequate for providing well-led services because:

  • The oversight and governance arrangements for the management and performance of the practice were ineffective.
  • The practice had a clear vision but it was not supported by a credible strategy to provide high quality sustainable care.
  • The practice did not always have clear and effective processes for managing risks, issues and performance.
  • The practice did not always act on appropriate and accurate information.
  • There was little evidence of systems and processes for learning, continuous improvement and innovation.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The practice received two warning notices which required them to be compliant with regulations by 31 March 2019. The practice also received a requirement notice regarding regulations which can be found at the end of the report.

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 vary the provider’s registration 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.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice