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Higham Ferrers Surgery Requires improvement

Reports


Inspection carried out on 26 February 2020

During a routine inspection

The practice was inspected in April and December 2018, they were rated requires improvement and inadequate at these inspections respectively. In January 2019, we inspected the practice again to ensure that improvements had been made and found that although improvements had been made, there were other concerns identified and the practice was placed into special measures.

We carried out an announced comprehensive inspection at Higham Ferrers Surgery on 26 February 2020. We also followed up on a warning notice that was issued to the practice for a breach of regulation 17(1) identified at the previous inspection in June 2019 and to ensure that the practice was now compliant with the regulations of the Health and Social Care Act 2012.

At the last inspection in June 2019 we rated the practice inadequate for providing safe, and well-led services because:

  • Systems in place to manage and mitigate risks were not effective. In particular in relation to recruitment, safety alerts, high-risk medicines and prescriptions.
  • There was a lack of consistent management and the practice failed to demonstrate that improvements could be sustained.

At the last inspection in June 2019 we rated the practice requires improvement for providing effective, caring and responsive services because:

  • Care and treatment was not being delivered effectively due to concerns over high-risk medicines.
  • Because they had failed to demonstrate that changes had been made to address the needs of the population.
  • Patient feedback had not been fully considered to make improvements for patients.

At this inspection, we found that the provider had satisfactorily addressed most of these areas, but other concerns were identified.

We based our judgement on the quality of care at this service is 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 have rated this practice as requires improvement overall. The practice is rated as requires improvement in the safe and well-led key questions.

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

  • We saw that improvements had been made in relation to prescriptions, recruitment procedures and medicine safety alerts but other gaps were identified. These were in relation to systems in place to identify and mitigate risks. The practice management team had been in place since July 2019 and had established new systems, but these were not yet fully embedded or working as intended.

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

  • We had seen improvements in the establishment of a two-member management team who had worked comprehensively to address the concerns raised at the previous inspection; newly established systems and processes were not yet fully embedded or working as intended. Gaps and other concerns were identified, and the practice acknowledged that further work was needed.

We rated the practice good for providing effective, caring and responsive services because:

  • We saw that improvements had been made to the monitoring of patients on high-risk medicines. Following the inspection, the practice was able to show us that further concerns that were identified in relation to the consistency and accuracy of information being used to monitor these patients was satisfactorily resolved.
  • Cervical screening and Childhood immunisation uptake results showed improvements.
  • Although patient satisfaction scores on the national patient survey were still low, the practice had taken actions to address these concerns and had conducted their own survey, unverified data from which, indicated that satisfaction had begun to improve.
  • Access to services did not always support positive outcomes for patients, we saw that some actions had been taken. Unverified data provided by the practice indicated that patient’s satisfaction had begun to improve.

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.

(Please see the specific details on action required at the end of this report).

The areas where the provider SHOULD make improvements are;

  • Ensure that clinical waste bins are stored securely, within a designated clinical waste area.
  • Improve checklists for emergency equipment to ensure levels and working status are checked.
  • Improve cervical screening uptake results.
  • Continue to take action to ensure that patient satisfaction increases.
  • Review access for patients outside of working hours to support patient services.

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

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 19 June 2019

During a routine inspection

We carried out an announced comprehensive inspection at Higham Ferrers Surgery on 3 December 2018. The overall rating for the practice was inadequate and the practice was placed in special measures.

From the inspection in December 2018 the practice was told they must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, the practice was told they should:

  • Develop mechanisms to share learning from investigations including significant events with the wider team.
  • Develop a replacement/maintenance plan for carpeted floors.
  • Develop plans to engage with the Patient Participation Group (PPG).

The full comprehensive report on the December 2018 inspection can be found by selecting the ‘all reports’ link for Higham Ferrers Surgery on our website at .

This inspection was an announced comprehensive inspection carried out on 19 June 2019, to confirm that the practice had made the recommended improvements that we identified in our previous inspection on 3 December 2018. Prior to the December 2018 inspection the practice had been rated as requires improvement in April 2018. The practice had failed to make the required improvements following the April 2018 inspection which led to the practice being rated as inadequate and placed into special measures in December 2018.

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.

The practice is rated as inadequate overall. The overall rating for this practice is inadequate due to concerns in providing safe and well-led services.

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

  • We found one member of staff who had not been safely recruited.
  • The practice did not have an adequate system in place to safely manage MHRA and other safety alerts.
  • High risk medicines monitoring was not effective and did not ensure patient safety.
  • Prescriptions were not being logged and monitored.

We rated the practice as requires improvement for providing effective, caring and responsive because:

  • Care and treatment was not being effectively delivered due to issues with high risk medicine monitoring and prescribing.
  • The practice had not made the changes it needed to in order to respond to the needs of the patients who used the practice.
  • Patient feedback had not been fully considered or addressed in order to improve the practice for patients.

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

  • The lack of consistent practice management presence was impacting on the quality of care and treatment.
  • Although we found the practice to be improved since our last inspection, we did not yet have evidence that the improvements would be sustainable over time.

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.

This practice was placed in special measures on 22 January 2019. Insufficient improvements have been made such that there remains a rating of inadequate for the safe and well led domain. Therefore the practice will remain in special measures and kept under review. Another inspection will be conducted within six months to ensure the required improvements have been made. If the required improvements have not been made we will take action in line with our enforcement procedures.

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 Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 03/12/2018

During a routine inspection

We carried out an announced comprehensive inspection at Higham Ferrers Surgery on 3 December 2018.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 4 April 2018.

During the inspection on 4 April 2018 we rated the practice as follows:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? - Requires improvement

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 have rated this practice as inadequate overall.

The overall inadequate rating affected all population groups so we rated all population groups as inadequate.

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

  • The review and actions to improve the number and mix of staff needed to provide safe clinical care was incomplete.
  • Staff reported that workload could be heavy when covering for others especially during staff holidays and sickness which in some instances affected their ability to deliver on their work and affected their morale.
  • There was no system to summarise patient medical records so they contained an accurate, up-to-date and easily accessible summary to enable clinical staff to readily access a patient’s significant and relevant medical history and make use of this, if appropriate, during a consultation.

We rated the practice as good for providing effective services because:

  • Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways tools and appropriately trained staff. However, we rated the services provided to the long-term conditions population group as requires improvement as the exception reporting for some diabetic care indicators were high in the latest QOF report (01/04/2017 to 31/03/2018). Exception reporting is the removal of patients from the calculations where, for example, the patients decline or do not respond to invitations to attend a review of their condition or when a medicine is not appropriate.

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

  • While the practice had made some improvements since our inspection on 4 April 2018 the practice was yet to demonstrate through verified data, the improvements made were being sustained.

We rated the practice as Inadequate for providing responsive services overall including the population groups because:

  • Patients were not able to access care and treatment in a timely way. While the practice had made some improvements since our inspection on 4 April the practice had not fully delivered on the review and actions to improve the number and mix of staff needed to match patient needs.
  • Some patient satisfaction data was significantly below local and national averages.

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

  • While the practice had made some improvements since our inspection on 4 April 2018, it had not appropriately addressed the Requirement Notice in relation to the arrangements in place for planning and monitoring the number and mix of staff needed to match patient needs and, providing a coordinated approach to practice management.
  • During this inspection we identified additional concerns that put patients at risk such as poor staff morale attributed to staff shortages and increased workload.
  • Leaders could not show that they understood the challenges to quality and sustainability.
  • The practice had not always acted on appropriate and accurate information such as having systems to ensure that patient medical records were summarised in a timely way to ensure patient safety.

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.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Develop mechanisms to share learning from investigations including significant events with the wider team.
  • Develop a replacement/maintenance plan for carpeted floors.
  • Develop plans to engage with the Patient Participation Group (PPG).

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.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 04/04/2018

During a routine inspection

This practice is rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Requires Improvement

Are services responsive? – Requires Improvement

Are services well-led? - Requires Improvement

We carried out an announced comprehensive inspection at Higham Ferrers Surgery on 4 April 2018 as part of our planned inspection programme.

At this inspection we found:

  • When incidents happened, the practice learned from them and improved their processes.
  • Not all safety systems were operating effectively. For example those related to staff recruitment and health and safety needed improvements.
  • Most staff had the skills, knowledge and experience to carry out their roles although the practice could not demonstrate oversight of clinical training for all staff.
  • Clinical performance data was comparable to the national and local data.
  • There were systems to review the effectiveness of the care and there was evidence of actions taken to support good antimicrobial stewardship (which aims to improve the safety and quality of patient care by changing the way antimicrobials are prescribed so it helps slow the emergence of resistance to antimicrobials thus ensuring antimicrobials remain an effective treatment for infection).
  • Patients we spoke with told us staff had treated them with compassion, kindness, dignity and respect.
  • Patients found the appointment system difficult to use and reported that getting an appointment on the day as well as future appointments could be difficult.
  • Governance processes and systems for practice management and quality improvement were not always operating effectively.
  • Systems for engaging with patients and acting on feedback were not well-established.

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. (Please refer to the requirement notice section at the end of the report for more detail).

The areas where the provider should make improvements are:

  • Complete the review of the immunisation status of clinical and non clinical staff and ensure a documented process to evidence compliance.
  • Complete the required maintenance to fire doors as recommended by the fire risk assessment.
  • Amend the complaint response letter so it shows the details to escalate to the Health Service Ombudsman should the complainant remain dissatisfied.
  • Develop an overview of the status of applicable safety alerts and their implementation status.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 02/12/2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Higham Ferrers Medical Centre on 02 December 2015. 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 appropriately managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

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

  • Information about services and how to complain was available and easy to understand.

  • There was continuity of care, with urgent appointments available the same day.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • There was a clear leadership structure, with clear aims and objectives to deliver high quality professional care. Staff felt supported by management.
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice