Lostock Hall Medical Centre

We carried out an announced focused inspection at Lostock Hall Medical Centre on 1 September 2021. Overall, the practice is rated as Requires Improvement.

Safe - Requires Improvement

Effective -Good

Caring – Good (rating awarded at the inspection 5 December 2019).

Responsive – Good (rating awarded at the inspection 5 December 2019).

Well-led – Requires Improvement

Following our previous inspection on 5 December 2019 the practice was rated Requires Improvement overall. The key questions safe and well led were rated as requires improvement and key question effective, caring and responsive and all the population groups were rated as good. We issued the practice requirement notices for regulation 12 (1) Safe care and treatment and regulation 17(1) Good governance.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Lostock Hall Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a follow up focused inspection to review our concerns identified previously. The inspection found most the areas identified previously had been addressed. Other concerns with recruitment procedures and some monitoring systems were identified. Both safe and well-led key questions remain as requires improvement. We rated the practice good for providing effective services. We did not inspect key questions caring and responsive as these were rated good at the previous inspection. All population groups remain rated as good.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included

• Conducting several staff interviews using video conferencing
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider
• Reviewing patient records to identify issues and clarify actions taken by the provider
• Requesting evidence from the provider
• A short site visit
• Face to face interviews with some staff.

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 as Requires Improvement

We found that the issues identified at inspection in December 2019 had been addressed. These included:

• Systems of managerial monitoring for staff training, clinical professional memberships and staff immunisation status were established.
• Staff were now encouraged to report and record significant events and incidents. Weekly clinical meetings and regular team meeting provided opportunities to share learning from these.
• Actions identified in relation to health and safety including fire safety and Legionella were in place and safe.
• Infection prevention and control (IPC) was well established and enhanced in response to COVID-19.

This inspection identified some areas that needed further improvement. We rated the practice as requires improvement for providing safe and well-led services because:

• Staff recruitment records were incomplete. For example, the practice had not assured themselves that staff working at the practice were suitable as satisfactory evidence of conduct in previous employment and identity checks had not been obtained consistently.
• Systems to monitor clinical decision making for those working in advanced clinical roles were informal and a system to monitor patient information work flowed to either a clinician or for filing was not in place.
• Systems to monitor the quality of patient medication reviews and review Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) agreements were not established.
• Governance processes around reviewing and updating policies and procedures were not comprehensive.
• An overarching quality assurance framework was not in place.

However:

• The practice had a clear vision, which had been delayed due to the pandemic but was now back on track to evolve the medical centre into a local community hub for social and health care activities.
• Patients spoken with were wholly positive about the care and treatment they and their families received.
• The practice team were committed to involving patients in their care and the type of services they provided.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.

We found two breaches of regulations. The provider must:

• Ensure specified information is available regarding each person employed.
• 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:

• Take action to secure the oxygen cylinder either to a wall bracket or within an oxygen trolley.
• Provide fire safety awareness training to locum GPs.
• Complaint response letters should include contact details for the Parliamentary and Health Service Ombudsman.

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