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The Haymarket Health Centre Good Also known as Haymarket Health Centre

Inspection Summary


Overall summary & rating

Good

Updated 13 September 2018

We previously carried out an announced comprehensive inspection at The Haymarket Health Centre on 11 January 2017. The overall rating for the practice was inadequate with inadequate for providing safe and well-led services, and requires improvement for providing effective, caring and responsive services. As a result, the service was placed into special measures and we issued a warning notice in relation to a breach in Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014: Good

Governance. We undertook an announced focused inspection on 3 July 2017 to follow up on the warning notice. We found that the provider had met the legal requirements of the warning notice. Following a period of special measures, we carried out an announced comprehensive inspection on 28 September 2017. Overall the practice was rated as good with requires improvement in providing responsive services and taken out of special measures. All of these reports can be found by selecting the ‘all reports’ link for The Haymarket Health Centre on our website at www.cqc.org.uk.

This inspection was an announced desk-based inspection carried out on 4 September 2018 to confirm that the practice had implemented recommendations identified in our previous inspection on 28 September 2017. This report covers our findings in relation to those requirements.

Overall the practice is now rated as good and good for providing responsive services.

Our key findings were as follows:

  • The practice had carried out an extensive analysis of calls made to the practice. Systems and processes to improve patient telephone access to appointments had been established however national data showed that patient satisfaction remained low.
  • Information about the practice’s complaints procedure was readily accessible to patients.

Additional improvements had also been made since our last inspection;

  • There was a system in place to regularly analyse significant events to identify any common trends, maximise learning and help mitigate further errors.
  • Visitors to the practice were briefed on the fire safety procedures and systems were in place to monitor and prevent obstructions to fire doors.

We saw one area of outstanding practice:

  • To support patients who lived in the Longton area to access appointments at the practice’s central access hub on Saturday mornings, the provider had sub-contracted a shuttle coach service, free of charge, for these patients.

In addition the provider should:

  • Consider additional ways of raising patient awareness of the types of appointments available and how patients are signposted to the most effective service to meet their needs.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 31 October 2017

The practice is rated as good for providing safe services.

  • Systems and processes to safeguard patients had improved. Staff were aware of how to raise a safeguarding concern, had received training relevant to their role and had access to internal leads and external safeguarding agencies.

  • Following the recruitment of a practice pharmacist, an effective system had been introduced to log, review, discuss and act on external alerts, such as the Medicines and Healthcare products Regulatory Agency (MHRA) alerts that may affect patient safety.

  • The practice system for prescribing high risk medicines on a shared care basis ensured patients had received the recommended monitoring before prescriptions were issued.

  • Staff felt able and were encouraged to raise events and demonstrated a clear understanding of the procedure and understood their responsibilities to report incidents and near misses. Events were recorded, investigated and shared but did not always result in learning and quality improvement. A regular analysis of events had not been carried out to identity common trends.

  • There were systems in place for identifying, assessing and mitigating most risks to the health and safety of patients and staff. However, some health and safety aspects required improved oversight.

  • The storage and handling of blank prescriptions was secure. However, the monitoring of uncollected prescriptions required review and this was immediately acted upon.

Effective

Good

Updated 31 October 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to the national average, although there were high levels of exception reporting in some areas.

  • Staff were aware of current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • The practice had a community assessment team that visited and assessed patients with complex needs in their own homes to help improve patient outcomes. Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • Staff had the skills and knowledge to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

Caring

Good

Updated 31 October 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey published in July 2017 showed patients rated the practice in line with others for most aspects of care.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services was accessible.

  • Staff treated patients with kindness and respect, and maintained confidentiality.

  • The practice had identified 208 (1.8%) of the patient list as carers. The practice community assessment team provided help and support to carers and signposted them to local services offering support and guidance.

Responsive

Good

Updated 13 September 2018

At our previous inspection on 28 September 2017, we rated the practice as requires improvement for providing responsive services. This was because:

  • Effective systems and processes to improve patient telephone access to appointments had not been established.
  • Information about the practice’s complaints procedure was not readily accessible to patients.

These arrangements had improved when we undertook a desk-based follow up inspection on 4 September 2018. The practice is now rated as good for providing responsive services.

Timely access to the service

The practice had carried out an extensive analysis of patient calls made to the practice. Systems and processes to improve patient telephone access to appointments had been made in response to these findings. For example, calls were redirected to a main call centre, a call handling system had been purchased, acute on the day appointments had been introduced and skype consultations were available for patients living in nursing homes. Call handling staff had been trained to direct patients to the most effective service to meet their needs. Patients could also book appointments on line and telephone consultations were available. A central access hub at The Haymarket Health Centre had been established to provide additional access to a range of appointments on Saturday mornings. To support patients who lived near the branch practice in Longton to access the hub, the provider had sub-contracted a shuttle coach service, free of charge, for these patients.

Comparison of data between 2017 and 2018 demonstrated that complaints to the Care Quality Commission and NHS Choices, in relation to patient satisfaction with telephone access to appointments, had significantly reduced. This was supported by the practice’s own internal survey. However, the national GP patient survey showed that patient experience of making an appointment and telephone access remained low. Of note, the survey methodology changed in 2018 therefore we cannot be sure that any change in scores was due to the change in methodology, or a genuine change in patient experience.

Listening and learning from concerns and complaints

Information about the practice’s complaints procedure was readily accessible to patients both within the practice and on their website.

Well-led

Good

Updated 31 October 2017

The practice is rated as good for providing well-led services.

  • Governance arrangements had improved. A clear leadership structure had been developed and implemented. Key roles and responsibilities had been developed across the team. Staff told us they felt supported by the partners and management team and considered significant improvements had been implemented since the last comprehensive inspection.
  • The partners and management team encouraged a culture of openness and honesty and demonstrated an oversight and understanding of the practice. They were aware of the continued improvements required to continue to improve patient outcomes and the quality of the service.
  • The practice had a clear vision to deliver high quality care and promote good outcomes for patients. Staff we spoke with were clear about the vision and their responsibilities in relation to it.

  • The practice had policies and procedures to govern activity. Various staff meetings were now established and recorded.

  • The practice sought feedback from staff and patients. The patient participation group was active to support patient feedback.

  • There was a focus on continuous learning and improvement. There was a system of peer review and staff felt supported with their personal development.

Checks on specific services

People with long term conditions

Good

Families, children and young people

Good

Working age people (including those recently retired and students)

Good

People experiencing poor mental health (including people with dementia)

Good

People whose circumstances may make them vulnerable

Good