You are here

Hilltops Medical Centre Requires improvement

Reports


Inspection carried out on 15 October 2019

During an inspection to make sure that the improvements required had been made

We carried out an announced inspection at Hilltops Medical Centre on 15 October 2019 as part of our inspection programme. We decided to undertake an inspection of this service following our annual review of the information available to us. This inspection looked at the following key questions:

  • Safe
  • Effective
  • Well-led

At the last inspection in November 2018 we rated the practice as good overall and requires improvement for providing safe services because:

  • Risks to patients and staff had not adequately been assessed and monitored, in particular with regard to infection prevention and control and blank prescription stationery security.
  • The practice did not evidence a consistent approach to recruitment through the provision of appropriate recruitment records.

At this inspection, we found that the provider had taken some action to improve in these areas. In particular, concerns with blank prescription stationery security had been resolved.

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 requires improvement overall and good for all population groups. The practice was rated as requires improvement for providing safe and well-led services.

We found that:

  • Patients received effective care and treatment that met their needs.
  • 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.
  • The way the practice was clinically led and managed promoted the delivery of high-quality, person-centre care.
  • There was a clear leadership structure. However, support for effective practice management was lacking. The practice proactively sought feedback from staff and patients, which it acted on.
  • There was evidence of continuous learning and improvement at all levels of the organisation.

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

  • Systems and processes to reduce risks to patient and staff safety needed strengthening.
  • Risks to patients and staff had not adequately been assessed, in particular those relating to staff immunity status, infection prevention and control, appropriate background checks for staff, significant events and safety alerts.

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

  • Systems and processes to reduce risks to patient and staff safety were lacking.
  • There was limited evidence of improvements made following our inspection in November 2018.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.

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

The areas where the provider should make improvements are:

  • Undertake risk assessments for any storage of hazardous substances for example, liquid nitrogen, storage of chemicals.
  • Ensure all policies, procedures and protocols are regularly reviewed and appropriate for implementation.
  • Maintain accurate recruitment records in line with practice policy and legislative requirements.
  • Complete timely appraisals for all staff.
  • Improve the support and implementation of practice managerial functions.

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 26 November 2018

During a routine inspection

This practice is rated as Good overall. (Previous rating 10/2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Hilltops Medical Centre on 26 November 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

  • The practice had some clear systems to manage risk so that safety incidents were less likely to happen. However, there were some areas that were in need of strengthening. In particular, risks in relation to infection prevention and control needed review. When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients we spoke with reported some difficulties with the appointment system and reported that they were not always able to access care when they needed it.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements is:

  • Ensure care and treatment is provided in a safe way to patients. (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:

  • Provide appropriate non-clinical staff with training on sepsis.
  • Undertake regular fire drills.
  • Implement the newly developed appraisal system and complete staff appraisals for all staff in line with practice policy.
  • Embed newly adopted processes for ensuring practice oversight of clinical registrations
  • Continue with efforts to improve patient satisfaction and performance in the national GP patient survey; with particular regard for patient experience during consultations.
  • Complete the proposed auditing of practice policies and procedures to ensure they are up to date and relevant.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Inspection carried out on 27 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hilltops Medical Centre on 27 May 2016. Overall the practice is rated as good.

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

  • The practice had an open and transparent approach to safety, including the reporting and recording significant events.
  • Risks to patients were assessed and generally well managed. However, we found that the medication review process neded to be more robust.
  • The system for cascading and implementing medical updates and alerts would benefit from review. Evidence to identify the action the practice had taken in response to updated guidance and thereafter updating records was not always clear.
  • Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, we noted that not all clinical staff had a comprehensive understanding of the requirements to establish parental responsibilities before treatment was provided.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Feedback from patients was positive about the care and approach from staff. However, some identified concerns regarding accessibility of appointments. We saw that urgent appointments were 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 partners and senior managers providing supportive and proactive direction for the practice. We noted that the CQC Registered Manager position was vacant at the time of inspection. The provider was in the process of applying for a new manager to be appointed.
  • Staff told us they felt supported by the partners and senior management. The practice routinely sought feedback from staff and patients from a variety of sources, which it acted on to improve services.
  • The provider was aware of and complied fully with the requirements of the duty of candour and had created and maintained a duty of candour log.

The areas where the provider should make improvement are:

  • Ensure robust systems and processes are in place for management of patient safety alerts and medication reviews, to ensure all discussions and actions are recorded appropriately
  • The practice should continue to monitor and seek improvements in outcomes for the National Patient Survey.
  • Consider a documented business plan to support the practice vision and strategy.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice