Archived: Half Penny Steps Health Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Half Penny Steps Health Centre on 29 July 2015. The overall rating for the practice was good. The full comprehensive report can be found by selecting the ‘all reports’ link for Half Penny Steps health Centre on our website at www.cqc.org.uk

We carried out an unannounced inspection at Half Penny Steps Health Centre on 22 May and 13 June 2017 in response to concerns received by the Care Quality Commission (CQC) that the practice was not providing safe care and treatment to its patients. The concerns specifically related to the practice having no lead GP and using locum GPs to run the service, without proper induction into practice procedures which included two week referrals and following up on hospital reports. There were also concerns in relation to there being no on site management support for staff and their lack of understanding of safeguarding vulnerable patients resulting in these patients being at risk. As a result a decision was made to take enforcement action against the provider where warning notices were issued for regulations 17; Good Governance and 18, Staffing.

We returned to the practice to assess if the provider had addressed our concerns in the warning notices and undertook an unannounced full comprehensive inspection, on 21 July 2017 to look in further detail into the areas of concern we had noted. As a result of our finding at this inspection we took further action and served the provider with a ‘letter of intent’ to take immediate enforcement action under section 31 of the Health and Social Care Act 2008 in relation to regulation 12: Safe Care and Treatment and regulation 17: Good Governance.

This report covers our findings from the inspection on 21 July 2017. The overall rating is inadequate.

Our key findings across all the areas we inspected were as follows:

• Patients requiring treatment for long term conditions (such as asthma) and high risk medicines were prescribed repeat medicine without adequate review.
• Effective systems were not in place to ensure handover of patient information is through an experienced clinician at all times.
• Effective clinical leadership, support and oversight to staff was not in place three days a week.
• The practice had systems in place for reporting and recording significant events and there was evidence of learning and communication with staff about significant events.
• There were formal systems and process in place to identify and assess risks to the health and safety of service users and staff.
• Staff had received appropriate mandatory training such as basic life support or safeguarding.
• Patient outcomes were hard to identify as no clinical audits had been carried out to improve the quality of care and there was no evidence that the practice was comparing its performance to others; either locally or nationally.
• There were no processes in place for patients or staff to give feedback about the service.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

The areas where the provider must make improvements are:

• 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. In particular – review and put in place measures to improve areas where patient outcomes are below average, in particular in relation to the proportion of patients excepted from the Quality and Outcomes Framework.

• 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 the duties.

In addition the provider should:

• Provide appropriate support and information to patients who are carers so their needs can be identified and met.
• Review systems to ensure patients with long term conditions are offered annual reviews.

• Review and update the business continuity plan
• Provide accessible information about the complaints procedure for patients

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains 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 practice 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.

Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Half Penny Steps Health Centre on 29 July 2015. The overall rating for the practice was good. The full comprehensive report can be found by selecting the ‘all reports’ link for Half Penny Steps health Centre on our website at www.cqc.org.uk.

This inspection was an unannounced focused inspection carried out on 22 May 2017 & 13 June 2017 in response to concerns received by the Care Quality Commission (CQC) that the practice was not providing safe care and treatment to its patients. The concerns specifically related to the practice having no lead GP and using locum GPs to run the service, without proper induction into practice procedures which included two week referrals and following up on hospital reports. There were also concerns in relation to there being no on site management support for staff and their lack of understanding of safeguarding vulnerable patients resulting in these patients being at risk. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection in relation to the GP practice only and not the ‘walk-in’ service.

At the inspection the concerns received by the CQC were substantiated and as a result a decision was made to take enforcement action against the provider where warning notices were issued for regulations 17; Good Governance and 18, Staffing.

Our key findings were as follows:

• The practice did not have systems in place for reporting and recording significant events and there was no evidence of learning and communication with staff about significant events.
• There were no formal systems and process in place to identify and assess risks to the health and safety of service users and staff. No assessment of the risk of, or preventing, detecting and controlling the spread of infections had taken place in the last two years.
• Staff had not received appropriate mandatory training such as basic life support or safeguarding.
• Patient outcomes were hard to identify as no clinical audits had been carried out to improve the quality of care and there was no evidence that the practice was comparing its performance to others; either locally or nationally.
• There were no processes in place for patients or staff to give feedback about the service.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

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

• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed are available to meet the needs of 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 the duties.

• Ensure care and treatment is provided in a safe way to patients

We therefore intend to carry out a full comprehensive inspection of the whole service to asses whether the care being provided fo people using the service is safe and meets the standards set out in the Health and Social Care Act 2008 (Regulated Activities 2014).

If we find the practice is providing care that is unsafe we will take action in line with our enforcement procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice