The Care Quality Commission
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Archived: Hightown Surgery

Overall: Good read more about inspection ratings

1 St George's Road, Hightown, Merseyside, L38 3RY (0151) 929 3603

Provided and run by:
SSP Health Ltd

Important: This service was previously managed by a different provider - see old profile
Important: The provider of this service has requested a review of one or more of the ratings.

All Inspections

22 October 2015

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced follow-up inspection of Hightown Surgery on 22 October 2015. This inspection was a follow-up to our inspection of 6 November 2014 when the practice was rated as ‘Inadequate’. The practice was placed into Special Measures in April 2015 and required to make significant improvements. The practice submitted an action plan detailing how they would make improvements and when they would be compliant with the regulations governing providers of health and social care.

At our follow-up inspection, we found the practice had made improvements across all five domains of safe, effective, caring, responsive and well led. Some improvement was still required in recruitment checks undertaken on locum GPs. Overall the practice is rated as Good

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

  • The practice had made improvements that promoted the safe treatment of patients. We saw that arrangements were in place for an appointed GP to lead multi-disciplinary team meetings at the practice to manage the care of palliative patients. A named GP was appointed as the safeguarding lead for the practice.

  • GPs delivering services were given sufficient time and support to familiarise themselves with systems in place at the practice, which resulted in the safer care and onward referral of patients to secondary care providers (hospitals and specialist clinics).

  • Recruitment checks for staff were in place. However, all checks as required by Schedule 3 of the Health and Social Care Act (Regulated Activities) Regulations 2014 were not complete for locum GPs and several checks had not been carried out before the locum GPs started working for the provider.

  • The practice had made improvements that increased the effectiveness of care for patients. The practice had a core group of locum GPs delivering services, which contributed to the effectiveness of treatment of patients by the practice and provided a degree of continuity of care.

  • The Patient Participation Group (PPG) for the practice told us things had improved since the CQC inspection of 2014. Patients reported that they had seen improvements in the continuity of care and that GPs were caring and inclusive towards them.

  • The provider had responded to the concerns of patients, communicating positively with the PPG.

  • The provider leadership team had responded positively to the feedback from Inspectors following the inspection of November 2014. The retention of locum GPs to deliver services was more robust, and patients were familiar with these GPs. Strong clinical leadership was provided by a Clinical Director, appointed by the provider within the last 12 months.

There are areas where the provider MUST make improvements. The provider must:

  • Ensure that all recruitment checks as required by Schedule 3 of the Health and Social Care Act 2008, are in place for all staff, including locum GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

6 November 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Hightown Surgery. Our inspection was a planned comprehensive inspection, which took place on 6 November 2014. The surgery is run by a large provider called SSP Health Ltd. Services are delivered under an Alternative Primary Medical Services (APMS) contract.

Our overall rating of the service is that it is inadequate. We found that at times, measures to reduce risk were not always followed, which exposed patients to the risk of unsafe practice. The locum GPs in place at the time of our inspection and the newly recruited practice nurse were caring in their interactions with patients, but the practice is rated as requiring improvement in the domain of caring. Patients were shown little consideration or empathy when they raised concerns about their treatment and the service provided by SSP Health Ltd. The practice was not responsive to patient concerns and did not involve patients in the planning of how services were delivered. The needs of particular patient groups were not fully met. The practice was not well-led; locum GPs were not fully supported by the provider, and worked largely in isolation.

Our key findings were as follows:

  • Treatment of patients was not always safe. Systems in place to promote patient safety were not embedded at practice level, as locums were unfamiliar with them.
  • Care and treatment delivered was not always effective. The locum GP was unable to provide any evidence of clinical audit in relation to updated guidance, for example, guidance issued on the review of treatment of patients with atrial fibrillation. The locum GP could not show or explain plans in place to conduct this audit. The locum GP could not show us any examples of review of patient referrals, peer review or benchmarking of patients treatment over time. The last audit conducted by the locum GP was in March 2014, before working for SSP Health Ltd. The locum GP followed systems to ensure that further treatment recommended by secondary (hospital care) was delivered to patients.
  • The practice was not caring towards patients. Patients were aware that both locums were leaving and that there were no meaningful plans or measures in place to recruit permanent GPs. The provider failed to acknowledge and address patients concerns about the lack of continuity of care. Telephone calls we received from patients in the days before our inspection, evidenced the level of distress this had caused to patients.
  • The provider was not always responsive to the concerns of patients, and failed to have regard to the complaints, comments and views of patients. The practice did not give information to patients on how long locum GPs would be delivering services for, and whether permanent GPs would be recruited for the practice.
  • The practice lacked strong supportive leadership. Arrangements were not in place to ensure that, at all times, there were sufficient GPs available to deliver services. Suitable arrangements were not in place to ensure that GPs were appropriately supported in relation to their responsibilities. The provider had no arrangements in place for a GP to take part in multi-disciplinary team meetings for shared care of palliative patients.

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

Importantly, the provider must:

  • Ensure that governance processes are applied and embedded at practice level. Check and monitor that shared learning from incidents is applied and embedded at practice level, particularly for locum GPs.
  • Have regard to the complaints and comments made and views expressed by patients and those acting on their behalf.
  • Communicate with and involve patients in a transparent way, particularly around continuity of GP care for patients, especially those with a mental health condition such as dementia.
  • Improve systems in place to ensure there are sufficient GPs available at all times to deliver services.
  • Improve leadership and support for GPs who work as locums, offering peer review of their work and support in the making of clinical decisions which may require discussion with other specialist clinicians, for example, a dementia or mental health lead for the provider.
  • Ensure arrangements are in place so that GP’s take part in multi-disciplinary team meetings for the care of palliative patients.

In addition the provider should:

  • Consider the needs of the working age population by allowing access to on-line appointments and repeat prescription ordering to increase service accessibility for patients.
  • Check oxygen supply for use in emergency is still suitable for safe use.

On the basis of this inspection and the concerns identified, which have resulted in an inadequate rating for two key domains and a rating of requires improvement in the other three domains, 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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice