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St Neots Health Centre Requires improvement

Reports


Inspection carried out on 27 June 2019

During a routine inspection

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

Inspection carried out on 25 May 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Neots Health Centre (Malling Health) on 18 October 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 18 October 2016 inspection 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 focused inspection carried out on 25 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 18 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • There were contractual restrictions placed on the practice in relation to the number of patients the walk in centre was funded to see by NHS England. In the event of full capacity, the practice had introduced effective systems and processes to ensure all patients were appropriately assessed before signposting to other services. We saw evidence that demonstrated the practice responded to any patients needing urgent treatment in a timely manner.Data had been collated and an audit completed; this audit identified the patient’s presenting symptoms and the actions taken by the practice to ensure these actions were appropriate.

  • Arrangements for safeguarding reflected relevant legislation and local requirements. Policies were accessible to all staff. Safeguarding concerns were clearly recorded in patients’ electronic records.

  • The practice had improved the infection prevention and control arrangements, a recent infection control audit had been undertaken with most identified actions completed.

  • We saw that the immunisation status of staff was recorded and risk assessments were in place.

  • Patient Group Directions had been adopted by the practice to allow nurses to administer medicines in line with legislation. A master sheet gave oversight ensuring they would be updated in a timely way.

  • The practice had implemented processes which evidenced that they proactively supported and encouraged patients who may be at risk of bowel or breast cancer to attend for screening.

  • Since our last inspection additional nurse practitioners had been employed. They told us they received good support from the practice and advice from GPs was easily accessible. The rotas were designed to ensure that at least one nurse practitioner was on duty when the healthcare assistant (HCA) was seeing patients. This ensured the HCA was fully supported to undertake the tasks delegated to them.

  • The practice evidenced that they had made every effort to engage all locum staff in the management of the practice; we saw evidence of meetings and regular letters sent to all locum staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 18 October 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the St Neots Health Centre and Walk In Centre on 18 October 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed but there was room for improvement.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff received training needed to provide them with the skills, knowledge, and experience to deliver effective care and treatment. Improvement was needed in the clinical support and guidance for the health care assistant.
  • Patients said they were treated with compassion, dignity and respect.
  • Information about services and how to complain was available and easy to understand.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Ensure safeguarding concerns are recorded appropriately within electronic clinical records.
  • Whilst patient group directions were signed, there was scope to ensure that the paper audit trail was comprehensive for all registered nursing staff.
  • Ensure infection control arrangements are effective and monitored on a regular basis.
  • Ensure that immunisation status of staff is risk assessed.
  • Proactively support and encourage patients who may be at risk of bowel or breast cancer to attend for screening.
  • Ensure that sufficient clinical support is in place for nurses and health care assistants.
  • Ensure that locum staff are involved and can influence improvement plans across the service.

The areas where the provider must make improvement are:

  • Assess and mitigate the potential risks around turning patients away from the walk in centre (due to contractual restrictions).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice