Archived: St Neots Health Centre

We carried out an announced focussed inspection at St Neots Health Centre (Malling Health) on 25 May 2017 and the practice was rated as good for providing safe, effective and well led services.

We had previously inspected St Neots Health centre on 18 October 2016. The overall rating for the practice was requires improvement. The practice had been rated as good for caring and responsive services and requires improvement for safe, effective and well led services. All previous report for St Neots Health Centre can be found by selecting the ‘all reports’ link for St Neots Health Centre (Malling Health) on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 27 June 2019 to follow up on concerns that had been raised.

We have rated this practice as requires improvement overall and for all population groups except families, children and young people.

We found that:

• The practice did not always provide care in a way that kept patients safe and protected them from avoidable harm.
• The systems and process in place did not always ensure that risk and performance was reviewed or that actions were taken to encourage improvement.
• Patients did not always receive effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• Staff told us there was good leadership within the practice, but they were not always aware of the senior management within the provider organisation of Malling Health (UK) Ltd.

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

• The practice did not have the recommended emergency medicines available and had not risk assessed this. The system and process in place did not demonstrate that all safety alerts were managed consistently to ensure they were all acted upon and monitored.

At this inspection we have rated the practice as requires improvement overall for all the population groups except families, children and young people which we have rated as good. Therefore, the effective domain has been rated as requires improvement because:

• Not all patients with a learning disability had received and annual review and the practice had missed the opportunity to complete a review or encourage attendance when the patient had attended the practice on other occasions.
• The practice Quality and Outcome Framework (QOF) for 2017/2018 and the unverified data for 2018/2019 the practice shared with us showed high exception reporting in some areas. The practice had not recognised this and had not reviewed the information and therefore, did not have a plan in place to ensure all patients were followed up in a timely manner.
• The recall system was not wholly effective as it did not ensure clinical staff would undertake opportunistic reviews of vulnerable patients when they attended the practice.
• The practice performance in relation to cervical screening was 67% this was below the CCG average of 71% and the national average of 72%. The practice up take for breast and bowel screening was below the CCG and national averages.

We rated the practice as good for providing caring services.

We rated the practice as good for providing responsive services.

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

• On the day of the inspection some staff we spoke with told us they had little knowledge of the senior management team within the provider organisation Malling Health (UK) Ltd.
• Systems and processes did not always support good governance; for example, in relation to emergency medicines and safety alerts.
• Systems and processes did not always support the management of performance, for example in relation to outcomes for patients as demonstrated in the Quality and Outcomes Framework and high exception reporting rates.
• The practice had not ensured the recall system for patients was wholly effective as some patients had attended the practice on many other occasions and had not received complete and appropriate reviews.

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.

The areas where the provider should make improvements are:

• Review the uptake of the national screening programme to encourage patients to attend their screening programmes.
• Continue to review and ensure safe and appropriate prescribing of antibacterial medicines.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP