The Care Quality Commission
  • Doctor
  • GP practice

Dr HP Borse & Partner

Overall: Good read more about inspection ratings

Meir Primary Care Centre, Weston Road, Stoke On Trent, Staffordshire, ST3 6AB 0300 123 0903

Provided and run by:
Dr HP Borse & Partner

All Inspections

9 August 2023

During an inspection looking at part of the service

We carried out an announced inspection at Dr HP Borse & Partner on 9 August 2023. Overall, the practice is rated as good.

Safe - requires improvement.

Effective -good.

Responsive – good.

Well-led – good.

Following our previous inspection on 21 September 2022, the practice was rated requires improvement overall in particular safe, effective and well led.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr HP Borse & Partner on our website at www.cqc.org.uk

Why we carried out this inspection.

We carried out this inspection to follow up breaches of regulation from a previous inspection.

The focus of our inspection included:

  • Safe, effective, responsive and well led domains.
  • A follow up on the breaches of regulations and advisory actions identified in our previous 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 using video conferencing.
  • 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.
  • Staff feedback questionnaires.

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:

  • Improvements had been made in the majority of areas identified at the last inspection 21 September 2022 as requiring improvement. However, there were some improvements to be made in the practice systems for recruitment.
  • Patients received effective care and treatment that met their needs.
  • Patients could access care and treatment in a timely way.
  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Medicines and Healthcare products Regulatory Agency alerts were not always promptly actioned.
  • Blood monitoring test results were not always either downloaded into the practice electronic systems or documented within the consult record prior to repeat prescribing for disease-modifying anti-rheumatic drugs (DMARDs). The dose of medicine prescribed also did not include day of week in this was to be taken.
  • 8 out of 20 patients prescribed a potassium sparing diuretic had not been in receipt of the required monitoring.
  • Asthma medicine review consultation records lacked detail.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We found a breach of regulations. The provider must:

  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The provider should:

  • Take action to improve cervical screening uptake.
  • Implement a system to improve patient compliance with medicine monitoring.
  • Consider the practice nurse workload when workforce planning.
  • Evaluate the effectiveness of the new management systems instigated and ensure these become embedded and are sustained.

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 Health Care

21 September 2022

During a routine inspection

We carried out an announced comprehensive inspection) at Dr H P Borse and Partner on 21 and 23 September 2022. Overall, the practice is rated as requires improvement.

Safe - Requires improvement

Effective - Requires improvement

Caring – Good

Responsive - Good

Well-led - Requires improvement

Following our previous inspection on 29 January 2018, the practice was rated good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr H P Borse and Partner on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up concerns reported to us.

  • We inspected safe, effective, caring, responsive and well led.
  • We investigated through the inspection of the practice the information of concern received to the Care Quality Commission, We found the information received to be almost wholly accurate.

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 using video conferencing.
  • 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.
  • Staff feedback questionnaires

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 have rated this practice requires improvement for providing safe services. This is because:

  • The practice’s safeguarding policy and lead were unknown to some staff.
  • The practice systems for recruitment, infection prevention and control, induction training and training oversight required improvement.
  • The practice’s long-term condition recall systems for the appropriate and safe use of medicines, including medicines optimisation and appropriate monitoring, required improvement.
  • Improvements were needed to the practice’s system for recording and acting on safety alerts.

We have rated this practice requires improvement for providing effective services. This is because:

  • Improvements were needed in performance related to cervical screening.
  • Systems and processes for managing risks, issues and monitoring required improvement.

We have rated this practice good for providing caring services. This is because:

  • Staff treated patients with kindness, respect and compassion and involved them in decisions about their care.

We have rated this practice good for providing a responsive services. This is because:

  • Patients could access care and treatment in a timely way.

We have rated this practice requires improvement for providing well – led services. This is because:

  • The practice did not have clear and effective processes for managing risks, issues and performance.
  • Improvement was needed in the completeion of complaint documentation.
  • The practice culture did not always effectively support high quality sustainable care, as staff were unaware of policies and support such as Freedom to Speak Up guardian’s and whistleblowing policies or where to locate them.

We found three 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.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed

The provider should:

  • Reinstate a patient Participation Group to gather patient views and consider an in-house patient survey.
  • Consider implementing strategies to improve the update of cancer screening such as cervical screening.
  • Implement systems and oversight of the practice Patient Group Directions (PGD)s.

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

3 January 2018

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr HP Borse & Partner on 17 October 2016. The overall rating for the practice was good with requires improvement in providing safe and well-led services. The full comprehensive report on the 17 October 2016 inspection can be found by selecting the ‘all reports’ link for Dr HP Borse & Partner on our website at www.cqc.org.uk.

Following the comprehensive inspection on 17 October 2016, we carried out an announced focused inspection on 27 June 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 comprehensive inspection on 17 October 2016. We continued to rate the practice as good overall with requires improvement in providing well-led services.

We carried out a further announced focused inspection on 3 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified at our previous inspection on 27 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection we found that the practice had addressed the concerns raised and is now rated as good for providing well-led services.

Our key findings were as follows:

  • The practice had established systems and processes to ensure good governance in accordance with the fundamental standards of care. The practice had reviewed and improved their systems for the monitoring and management of emergency medicines held at the practice and in GP bags to ensure they were effective.

  • The practice had carried out a regular analysis of significant events to identify any patterns and trends but did not document the learning.

  • The practice had developed a documented prescription security protocol and there was now an effective system in place for tracking blank prescriptions throughout the practice and for ensuring the improved security of these.

  • Arrangements had been made to secure the safety of fridge power points to mitigate the risk of them being accidently switched off.

However, there were also areas of practice where the provider needs to make improvements.

In addition the provider should:

  • Document the learning from each significant event and include the designated person for actioning the event, date for completion and sign off date.

  • Review the process for gaining GP oversight of all non-collected prescriptions before they are destroyed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

27 June 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr HP Borse & Partner on 17 October 2016. The overall rating for the practice was good with requires improvement in providing safe and well-led services. The full comprehensive report on the 17 October 2016 inspection can be found by selecting the ‘all reports’ link for Dr HP Borse & Partner on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 27 June 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 at our previous inspection on 17 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 rated as good.

Our key findings were as follows:

  • Improvements had been made in the reporting, recording and sharing of significant events to maximise learning.

  • A system had been implemented to receive and act on alerts about medicines that may affect patients’ safety.

  • Recruitment checks had been improved and met legislative requirements.

  • All staff had been made aware of the safeguarding lead and the contact details for external safeguarding teams were accessible in most areas.

  • An injectable analgesic medicine for pain relief had been obtained in the event of an emergency. However, the provider did not have an effective system in place for the monitoring and the management of emergency medicines.

  • A system had been implemented for the management and security of prescription pads but this was not always effective.

  • A system had been implemented for the monitoring of uncollected prescriptions.

  • Fridge temperatures where vaccines were stored were checked and recorded on a daily basis. Improvements had been made to securing the safety of the power point of fridges but did not mitigate the risk of one fridge being accidently turned off.

  • Some improvements had been made to the governance arrangements. However, not all arrangements for assessing and monitoring risks were effective or embedded into practice.

We also saw the following best practice recommendations we previously made in relation to providing a responsive service had been actioned:

  • The complaints procedure had been made readily accessible to patients and included the escalation process should they not be happy with the outcome or the management of their complaint.

  • A log of verbal complaints was maintained so that discussions with patients were recorded and analysed for trends.

However, there were also areas of practice where the provider needs to make improvements.

The provide must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. In particular, ensure systems for the monitoring and management of emergency medicines are effective.

The provider should:

  • Carry out a regular analysis of significant events to identify any patterns and trends and maximise learning.

  • Improve systems for the monitoring of emergency medicines held in GP bags to ensure they are in date.

  • Ensure the system for tracking prescriptions through the practice is effective and prescription forms are kept secure.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

17 October 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr HP Borse & Partner on 17 October 2016. Overall the practice is rated as requires improvement.

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

  • The practice had good facilities and was equipped to treat patients and meet their needs.
  • Patients said they found it easy to make an appointment with urgent appointments available on the same day.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • Patients said they were treated with compassion, dignity and respect and they felt listened to and were involved in decisions about their care and treatment.
  • The practice had a patient participation group and had implemented suggestions for improvements and had made changes to the way it delivered services as a consequence of feedback.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Risks to patients were assessed but not always well managed. For example, there was not an effective system in place for ensuring all significant events were recorded, shared and regularly reviewed to identify any common trends, maximise learning and help mitigate further errors.
  • There was not an effective system in place that provided assurance that appropriate action was being taken in respect of all patient safety alerts.
  • Not all staff we spoke with were aware of who the lead for safeguarding was. Contact numbers for external safeguarding agencies were not readily accessible in all rooms.
  • Information about how to complain was available but not readily accessible. The practice responded quickly to issues raised, however one complaint had not been managed in line with the complaints procedure and verbal complaints were not recorded to help identify common trends.
  • Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment and were supported with their personal development.
  • We observed staff members were courteous and very helpful to patients and treated them with dignity and respect.
  • Feedback from residential homes included that staff were mainly responsive, helpful, courteous and polite.
  • The results from the GP national patient survey showed patients expressed mostly higher satisfaction levels in relation to the experience of their last GP appointment and access to appointments compared to the local Clinical Commissioning Group and the national averages.

The areas where the practice must make improvements are:

  • Ensure that all significant events, incidents and near misses are recorded, discussed and audited to maximise learning and regularly reviewed to identify patterns and trends.
  • Have a system in place that details the actions taken in response to all alerts issued by external agencies, for example from the Medicines and Healthcare products Regulatory Agency (MHRA).
  • Ensure recruitment checks for new staff meet legislative requirements.

The areas where the practice should make improvements are:

  • Improve governance arrangements for assessing and monitoring risks and the quality of the service provision.
  • Ensure all staff are made aware of the safeguarding lead and the contact details for the local safeguarding teams are readily accessible.
  • Consider expanding the practice emergency medicines to include an injectable analgesic for pain relief or carry out a risk assessment as to why this is not required.
  • Develop a system for the management and security of prescription pads and improve the system for the monitoring of uncollected prescriptions.
  • Ensure the complaints procedure is accessible to patients, complaints are managed in line with the procedure, and patients are advised of the escalation process should they not be happy with the outcome or the management of their complaint.
  • Carry out an annual review of complaints to identify any common themes and trends and consider keeping a log of verbal complaints so that discussions with patients are recorded and analysed for trends.
  • Ensure fridge temperatures where vaccines are stored are checked and recorded on a daily basis and consider securing the safety of the power point.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice