Archived: Spring Terrace Health Centre

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Spring Terrace Health Centre on 10 March 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe, effective and responsive services and for being well-led. Improvements were also required to ensure caring services are provided.

• Risks to patients were not minimised sufficiently because some systems and processes were not in place to keep them safe, for example, there was no health and safety risk assessment and staff had not received fire training. Staff were clear about reporting incidents, near misses and concerns but they did not receive any outcomes or learning from this.
• There were systems in place to monitor infection control and medicines were managed effectively.
• There was a limited amount of clinical audits in place to improve patient outcomes or systems for learning. Some patients who had long term conditions or were on the practice’s mental health register had not received an annual health check. There were gaps in the management of training for staff.
• Data showed patient outcomes were in line or above average for the locality. Staff referred to guidance from National Institute for Health and Care Excellence and used it routinely. We saw good evidence of multi-disciplinary team working.
• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Patients said however sometimes they found staff talked loudly at the reception window and felt their privacy could be compromised.
• Patients reported difficulty in obtaining appointments. Patients and staff said one of the main problems was not being able to book appointments in advance. Patients we spoke with told us and staff confirmed there was a queue of patients outside the practice every morning to ensure they could obtain an appointment.
• There were high numbers of complaints which mostly referred to the appointment system and patients being unable to obtain an appointment.
• The practice had good facilities and was equipped to treat patients.
• Although there was a formal leadership structure the arrangements for governance and performance did not operate effectively.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure systems and processes are established and operated effectively in order to assess, monitor and improve the quality of service provided in carrying out the regulated activities.
• Ensure risks are effectively assessed, monitored and mitigated in relation to the health, safety and welfare of patients receiving care and treatment in relation to patients being able to obtain a consultation with a healthcare professional.
• Ensure records which are necessary to be kept in relation to staff and management of the regulated activities are maintained.
• Ensure they have a formal system for clinical audit which improves quality.
• Ensure staff receive appropriate training in order to carry out the duties they perform.
• Ensure that they can demonstrate that Healthcare professionals continue to meet professional standards which are a condition of their ability to practice or a requirement of their role.

The provider should;

• Document a clear rationale in their staff files as to why a DBS check was not appropriate for non-clinical staff.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice