Archived: Lakeside Healthcare at Rushden

Lakeside Healthcare at Rushden was inspected previously:-

• A comprehensive inspection was completed on 29 November 2018 as part of our inspection of the provider (Lakeside Healthcare Partnership). Lakeside Healthcare at Rushden were rated as Requires Improvement overall with Requires Improvement for Safe and Well-led and the population group of Long term conditions. A warning notice was issued for Regulation 17 (Good Governance)which required the practice to be compliant by 31 January 2019.

• A focused inspection was completed on 6 June 2019 to follow up on the warning notices and breach of legal requirements found at the comprehensive inspection in November 2018. Whilst we found compliance in some areas of the warning notices further concerns were identified, so we inspected two further key questions of safe and well-led which resulted in the practice being rated inadequate overall. The population group people with long term conditions remained rated at requires improvement. We did not inspect the key questions of Effective, Caring and Responsive at this inspection. We served two further warning notices in relation to Regulation 12 Safe Care and Treatment and Regulation 17 Good Governance which required the practice to be compliant by 6 September 2019. The practice was placed in special measures for a period of six months

We carried out an announced comprehensive inspection at Lakeside Healthcare at Rushden on 11 December 2019. We also looked at the breaches covered in the warning notices for Regulations 12 and 17 served in June 2019.

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 Good overall.

We found that:

• Lakeside Healthcare at Rushden demonstrated they had been responsive to the findings of the previous reports and were able to evidence significant improvements had been made. We saw clinical leadership and oversight had improved and GP partners and the majority most of the practice staff we spoke with had been fully engaged in the changes that had been made.
• Patients’ health was monitored in a timely manner to ensure medicines were being used safely and followed up on appropriately.
• The practice had made improvements to their governance arrangements and had taken most of the appropriate steps required to ensure patients remained safe.
• Patients were supported, treated with dignity and respect.

We have rated the practice as requires improvement for providing an effective service because the population groups of long term conditions and working age people (including those recently retired and students) were rated as requires improvement :-

• The percentage of women eligible for cervical screening was below the national average of 80% and the practice did not have a failsafe system in place to ensure that patients had received their results and referred to secondary care where appropriate.
• Exception reporting for patients with long term conditions was above the CCG and national averages.

The areas where the provider should:

• Continue to carry out monthly fire safety and legionella water temperature testing to ensure risks are mitigated and actions taken where appropriate.
• Review process for exception reporting and make improvements in those areas highlighted in the Quality Assurance Framework.
• Improve uptake of cervical screening and ensure outstanding test results are monitored.
• Implement actions from the GP patient survey to improve patient satisfaction.

I am taking this service out of special measures. This recognises the significant 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

Lakeside Healthcare at Rushden was inspected previously on

29 November 2018 under the comprehensive inspection programme as part of our inspection of the provider (Lakeside Healthcare Partnership).

The practice was rated as Requires Improvement overall. They were rated as requires Improvement for providing a safe and well-led service. Effective, Caring and Responsive were rated as Good. All the population groups were rated as Good with the exception of people with long term conditions which was rated as requires improvement.

A breach of legal requirements was found in relation to governance arrangements within the practice. A warning notice was issued which required the practice to be compliant by 31 January 2019.

We carried out an announced focussed inspection at Lakeside Healthcare at Rushden on 6 June 2019.

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. We have rated the practice as inadequate for providing safe and well-led services. The population group people with long term conditions remains rated at requires improvement

We found that:

• At this inspection we still had concerns about the clinical oversight and governance arrangements in place.
• The leadership, governance and culture of the practice did not always promote the delivery of high quality person-centred care.
• Patients’ health was not always monitored in a timely manner to ensure medicines were being used safely and followed up on appropriately.
• The practice had made some improvements to their governance arrangements and had taken some of the appropriate steps required to ensure patients remained safe.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.

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

• The overall governance arrangements were ineffective.
• The practice did not have always have clear and effective processes for managing risks, issues and performance.

The areas where the provider must make improvements are:

• 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.

In addition, the provider should:

• Continue to review the staff training requirements for health care assistants.
• Review their QOF reporting process to ensure that exceptions are appropriate.

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.

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

We carried out an announced comprehensive inspection at Lakeside Healthcare at Rushden, formally known as Rushden Medical Centre on 29 November 2018 as part of our inspection programme.

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.

I have rated this practice as requires improvement overall.

This means that:

• People were protected from avoidable harm and abuse and that legal requirements were met.
• The prescribing of high risk medicines, warfarin and Ace inhibitors did not keep people safe.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• People’s needs were met by the way in which services were organised and delivered.
• The leadership, governance and culture of the practice did not always promote the delivery of high quality person-centred care.

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

• The practice did not always act on appropriate and accurate information.

We identified an area of outstanding practice:

• Lakeside Healthcare Partnership, as a provider, had their own designated safeguarding team who were employed within the partnership from Monday to Friday to cover all aspects of the safeguarding processes to protect both children and adults. The team covered all aspects of the safeguarding role with a view that this increased staff’s knowledge of at risk patients and ensured a level of continuity. The members of the team were easily contactable during working hours via telephone or the task system on the clinical record system. Staff told us, and we found evidence, that as dealing with safeguarding concerns was the only role of the dedicated team that this enabled them to produce much more detailed safeguarding referrals and child protection reports.

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.

In addition, the provider should:

• Review the safeguarding process to ensure all staff have sight of safeguarding indictors on the clinical system.
• Review the system for recording and documenting actions in respect of significant events and complaints to ensure that actions and learning is clear.
• Review the staff training requirements for health care assistants.
• Take steps to ensure that older MHRA alerts are re-visited and reviewed.
• Review the availability of extended hours appointments.
• Review the process to improve the identification and recording of carers.
• Review their QOF reporting process to ensure that exceptions are appropriate.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice