Holbeach Medical Centre

We had previously carried out an announced comprehensive inspection at Holbeach Medical Centre on 16 January 2019.

At that inspection we rated the practice as inadequate in safe, responsive and well-led and requires improvement in effective and caring. The practice was rated as inadequate overall and was placed in special measures.

The full comprehensive report on that inspection can be found by selecting the ‘all reports’ link for Holbeach Medical Centre on our website at www.cqc.org.uk.

At that inspection we identified breaches of Regulation 12 (Safe care and treatment) and 17 (Good Governance) of the Health and Social Care Act and issued the practice with a Warning Notice. A follow up inspection was carried out on 18 April 2019 that confirmed that practice was now meeting the legal requirements in relation to the breaches of the regulations.

This inspection was an announced comprehensive inspection, carried out on 4 September 2019.

Our key findings from this inspection were;

• The practice had effective systems to protect patients from abuse and avoidable harm.
• Patients received effective care and treatment that met their needs.
• The process for managing patients in receipt of high- risk medicines was not always effective.
• 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.
• 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:

• Continue to review all patients in receipt of high- risk medicines.
• Maintain oversight and actively manage the process for summarising and re-coding new patient notes.
• Continue to review telephone access and appointment availability.
• Continue to review the process to identify additional carers.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

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

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.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Holbeach Medical Centre on 16 January 2019. This was as part of our inspection program.

Our judgement of the quality of care at this service is based 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.

This practice is rated as inadequate overall. (At our previous inspection on 12 August 2015 we rated the practice as good)

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

• Recruitment procedures did not adequately protect patients from avoidable harm and abuse.
• The prescribing of medicines to some patients did not keep them safe.
• The system for dealing with patient safety and medicines alerts was not effective.
• The practice had not taken appropriate action to address issues relating to health and safety, infection prevention control and fire safety audits.

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

• Not all staff had not completed the practices mandatory training.
• Childhood immunisations rates were low for two-year olds.
• Cervical cancer screening was lower than both CCG and national averages.

This area affected all population groups so we rated all population groups as requires improvement.

We rated the practice as requires improvement for providing caring services.

• The numbers of carers that had been identified was low.
• Patient’s whose first language was not English were not provided with information in a format they could readily understand.
• There was no consistent process for supporting bereaved patients.
• There was limited opportunity for patients to discuss issues in a confidential manner.

We rated the practice as inadequate for providing a responsive service because:

• Feedback from patients relating to access to services was significantly lower when compared with local and national averages.
• Complaints information was not readily available to patients.
• The surgery was not open throughout the whole of the contracted core hours and there was no information available to patients as to what they should do when closed.
• Information to patients whose first language was not English was not provided in a format that assured they could understand.
• Feedback from patients through the national GP survey were generally lower than average. There was limited evidence of what the practice had done to address the concerns.

This area affected all population groups so we rated all population groups as inadequate.

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

• There were not always clear responsibilities, roles and systems of accountability to support good governance and management.
• The practice did not always have clear and effective processes for managing risks.
• There was a back-log of new patient notes that had not been summarised, and no plans were in place to address the issue.
• Practice management was being left in the hands of an inexperienced member of staff with little support.
• The practice had been without a Registered Manger since 30 September 2018. No notification had been submitted to CQC. The application for a new Registered Manager was not submitted until 14 January.

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 addition, the practice should also:

• Review their process for re-call of patients with long term conditions.
• Review and consider how they can increase the immunisation rates for children.
• Review and consider how they can increase the uptake of cervical cancer screening.
• Review their process for obtaining patient feedback.
• Review their process to ensure patients received information in a form they could understand.
• Review their process of identifying carers.
• Review their process to provide consistency when dealing with bereaved patients.
• Review staffing to provide support, guidance and assistance to the practice manager.

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.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice