The Care Quality Commission
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Archived: Hill Top Medical Centre

Overall: Inadequate read more about inspection ratings

15 Hill Top Road, Oldbury, West Midlands, B68 9DU (0121) 422 2146

Provided and run by:
Hill Top Medical Centre

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

All Inspections

31 October 2022

During an inspection looking at part of the service

We carried out an unannounced comprehensive at Hilltop Medical Centre on 31 October 2022. Overall, the practice is rated as Inadequate.

Safe - Requires Improvement

Effective - Requires Improvement

Caring - Requires Improvement

Responsive - Inadequate

Well-led - Inadequate

Following our previous inspection on 1 August 2018 rated Good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Hill Top Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

Following a review of information we held about the provider which triggered the inspection.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • 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 and
  • information from the provider, patients, the public and other organisations.

We found that:

  • The practice had a safety alert protocol in place, however, the practice was unable to demonstrate that it consistently acted on safety alerts.
  • The practice had some arrangements to identify risks, however we found staff had not received the recommended immunisations and no risk assessments had been carried out to identify potential risks to patients and staff in the absence of appropriate immunisations
  • On reviewing staff records, we found some staff had not received recent appraisals and we identified gaps in staff training.
  • The practice was unable to demonstrate they had systems in place for the clinical supervision of staff in advanced clinical roles.
  • Patient feedback was negative in relation to access and appointment availability. The practice had implemented an action plan to improve access by an increase in staff. However, on the day of inspection, staff told us that staff shortages were impacting on appointment availability.
  • Governance processes needed strengthening to ensure risks were mitigated. We found there was no governance lead in place to oversee systems and processes were adhered too and the actions from risk assessments had not been acted on.
  • The practice had some systems in place to provide care in a way that kept patients safe, but these required strengthening to ensure effective communication with staff.
  • We found some patients had not received the appropriate reviews to ensure effective care was provided that met their needs.

We found breaches of regulations. The provider must:

  • 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.

The provider should:

  • Continue to encourage patients to attend for cervical screening and childhood immunisations
  • Monitor staff training to gain assurances all staff are up to date with the latest training modules.

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.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

1 August 2018

During an inspection looking at part of the service

This practice is rated as Good overall. (Previous inspection October 2017 – Good overall, with requires improvement rating for providing Safe services)

The key questions are rated as:

Are services safe? – Good

We carried out an announced focused inspection at Hill Top Medical Centre, on 1 August 2018. This inspection was in response to previous focused inspection at the practice in October 2017, where breaches of the Health and Social Care Act 2008 were identified. You can read the report from our last focused inspection on 11 October 2017; by selecting the 'all reports' link for Hill Top Medical Centre on our website at www.cqc.org.uk.

At this inspection we found:

  • The practice had introduced an effective system to routinely review the effectiveness and appropriateness of the care it provided to ensure patients on high risk medicines were monitored on a regular basis.
  • At previous inspections, results from the national patient survey showed accessing the practice by telephone was below local and national averages. The practice had implemented increased access through longer opening hours including weekends and encouraging patients to use the online services available.
  • Since the last inspection the number of patients using the online facilities had increased from 26% to 40%.
  • All staff had received refresher training on where the emergency equipment was situated in the case of unforeseen medical emergencies.
  • The practice continued to demonstrate improvements in their achievements of the quality and outcomes framework (QOF) system and effectively monitored patients to ensure they were receiving the appropriate monitoring and care.

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

11 October 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 Hill Top Medical Centre on 28 November 2016. The overall rating for the practice was good. However, we rated the practice requires improvement for providing effective care (one of the five questions we ask practice). The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Hill Top Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 11 October 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 28 November 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.

  • During our previous inspection in November 2016 we found that the systems to monitor patients prescribed high risk medicines were not always effective. At this inspection we saw the practice had introduced regular searches to ensure monitoring of high risk medicines such as Disease-modifying anti-rheumatic drugs (DMARDs). However, the practice had not considered all high risk medicines for regular review.
  • The practice had reviewed its processes for prescription stationery and ensured that they were logged to minimise the risk of fraud.
  • The practice had carried out an Infection Prevention and Control (IPC) audit and action was taken to improve the identified areas.
  • The practice had reviewed its recruitment process and evidence we looked at demonstrated that appropriate processes were in place and being followed.
  • All staff had been made aware of the location of emergency equipment and staff members we spoke with were able to demonstrate this.
  • The practice had purchased two hearing loops and door bells had been installed to enable those patients using a wheel chair to call for assistance.
  • During our previous inspection we saw results from the national GP patient survey published in July 2016 showed that patients’ satisfaction with how they could access care by telephone was below local and national averages. During this inspection survey results published in July 2017 did not reflect any improvements. However, since 2 September 2017 the practice had changed its opening hours and was now open from 8am to 8pm Monday to Friday and weekend access was also available. The practice had increased the number of patients registered to use online services. Data we looked at showed 38% of patients on the practice list were registered and 26% were actively using the service.
  • Examples of complaints we looked at from the previous 12 months demonstrated that they were responded to appropriately with all responses being documented.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way through effective systems to mitigate risks to patients prescribed high risk medicines.

In addition the provider should:

  • Ensure all staff are aware of the location of the spare emergency medicine kit.
  • Continue to monitor QOF achievement to ensure improvement is maintained.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

28 November 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Hill Top Medical Centre on 28 November 2016. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Learning was shared with staff and reported to external agencies when required.
  • Required recruitment checks had been made before a member of staff was employed to work at the practice. However, the physical and mental health of newly appointed staff had not been considered.
  • The systems in place to mitigate risks to patients who took high risk medicines were not always effective.
  • An overarching training matrix and policy was in place to monitor that all staff were up to date with their training needs and received regular appraisals.
  • Patients said they found urgent appointments were available the same day but the appointment system was a cause for complaint for a number of patients when trying to make a routine appointment to see a GP.
  • Feedback from patients about their care was consistently positive and was reflected in the national patient survey results; last published in July 2016.
  • The practice had reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
  • The practice had a written set of objectives and values supported by a written business plan that reflected this strategy and ensured the future direction of the practice was monitored and evaluated.
  • The practice had visible clinical and managerial leadership. Most governance and audit arrangements were effective.

The areas where the provider must make improvement are:

  • Ensure that systems to mitigate risks to patients prescribed high risk medicines are fully effective.
  • Implement effective systems to manage patients with long-term conditions, specifically asthma and diabetes.

The areas where the provider should make improvement are:

  • Ensure that infection prevention control audits take into account the most recent nationally recognised guidelines.
  • Implement processes to demonstrate that the physical and mental health of newly appointed staff have been considered to ensure they are suitable to carry out the requirements of the role.
  • Review safeguarding policies to ensure they include updated categories and definitions for types of abuse. Ensure all staff are familiar with the policies and are aware of the safeguarding leads.
  • Implement an effective prescription tracking system to minimise the risk of fraud.
  • Ensure all staff are aware of where emergency medicicines and equipment are kept.
  • Complete modifications to ensure that the premises are suitable for patients with reduced mobility and any hearing impairment.
  • Explore ways to improve telephone access for patients.
  • Record verbal interaction and outcomes when resolving complaints over the telephone.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice