Buttercross Health Centre

This practice was rated October 2018 as Requires Improvement overall.

We carried out an announced comprehensive inspection at Buttercross Health Centre on 5 June 2019 to follow up on breaches identified at a previous inspection in 22 and 23 August 2018.

At the last inspection in October 2018 we rated the practice as requires improvement overall and requires improvement for providing safe, effective and well led services and requires improvement for the patient population groups of people with long-term conditions and mental health needs.

Key concerns were:

Safe

The areas where the provider must improve were that safe care and treatment was provided regarding infection prevention, staff immunisation status was in line with Public Health England (PHE) guidance. In addition, improvements were required related to fire safety, checks for safe equipment, medicines management and mandatory training for staff. Improvements were also needed in record keeping for the outcomes of patient specific meetings, for the sharing information for significant events and complaints.

Effective

The provider must ensure patients received an adequate review of their care and treatment needs on a regular basis. Improvements were needed in the monitoring systems for the quality of care outcomes (QOF) and clinical management of long-term conditions including mental health. The provider should improve how they review and maintain practice held disease registers such as for patients who are homeless and continue with a programme to develop cervical cancer screening uptake.

Well Led

The provider must ensure there were effective systems and processes for good governance. Improvements were needed for the processes in place with regards complaints and concerns and management to the classification of complaints and concerns, the clinical audit programme and the risk management of emergency cover at the branch surgery at Ilchester as a GP is not on site to respond to medical emergencies.

At this inspection, we found that the provider had satisfactorily addressed these areas.

We based our judgement of the quality of care at this service is 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 the practice as Good overall.

In particular we found:

• Care and treatment was provided in a safe way to patients with regards to infection prevention and control including the necessary information was available regarding staff immunisation status in line with Public Health England (PHE) guidance.
• There were safe systems in place for fire safety including regular fire drills, checks for safe equipment, including calibration and mandatory training completion for staff.
• Medicines were stored safely and risk assessments for emergency medicines were in place.
• There were effective systems in place to respond to medical emergencies at the registered location and at the branch surgery.
• Patients received an adequate review of their care and treatment needs on a regular basis. The practice continued to implement actions to improve the quality of care outcomes (QOF) and clinical management of long-term conditions including mental health.
• Efforts to improve the uptake of cervical screening had increased the number of eligible patients participating to above 83%.
• Childhood immunisation uptake rates were above the World Health Organisation (WHO) targets
• Significant improvements had been made in the care and provision for patients with mental health needs.
• Feedback from patients was positive, staff were reported to be kind and caring.
• The health coach staff team worked well and led on patient communication, community support and monitoring of the most vulnerable patients.
• Disease registers were in place to identify and prioritise meeting patient’s needs.
• The documentation, record keeping processes and follow-up action for patient specific action taken at meetings, including safeguarding and meeting ‘huddles’ was in place.
• There was documentation to support actions taken, lessons learnt and the sharing of information within the practice team related to significant events and complaints
• There were effective systems and processes to ensure good governance including staffing levels, audit, the management of complaints and concerns

Areas where the provider should continue to develop:

• The practice should continue with their program to improve meeting the needs of the patients with long term conditions.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

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

This practice was rated October 2018 as Requires Improvement overall.

We carried out an announced focused inspection at Buttercross Health Centre on 7 March 2019. This inspection was carried out to follow up on breaches of regulations and areas identified for improvement where we had rated the key questions of safe, effective and well led and the patient population groups of people with long-term conditions and mental health needs as requires improvement. We had implemented two regulatory requirements, Regulation 12 – Safe care and treatment and Regulation 17- Good governance and identified areas the provider should take action to improve.

These were:

Safe

The areas where the provider must improve were:

• Ensure care and treatment was provided in a safe way to patients with regards to infection prevention and control including the necessary information is available regarding staff immunisation status in line with Public Health England (PHE) guidance.
• Ensure there were safe systems in place for fire safety including regular fire drills, checks for safe equipment, including calibration and mandatory training completion for staff.
• Ensure medicines were stored safely and risk assessments for emergency medicines were in place.

The areas where the provider should make improvements were:

• Review the documentation, record keeping processes and follow-up action for patient specific action taken at meetings such as safeguarding meetings and ‘huddles’.
• Review documentation and processes to demonstrate actions taken, lessons learnt and the sharing of lessons within the practice team for significant events and complaints were in place.

Effective

Areas where the provider must improve:

• Ensure that patients received an adequate review of their care and treatment needs on a regular basis.

The areas where the provider should make improvements were:

• Continue to implement actions to improve the quality of care outcomes (QOF) and clinical management of long-term conditions including mental health.
• Review and maintain practice held disease registers such as patients who are homeless.
• Review cervical cancer screening uptake.

Well Led

• Ensure there were effective systems and processes to ensure good governance.

The areas where the provider should make improvements were:

• Review the process in place with regards to the classification of complaints and concerns and the subsequent investigation.
• Review audits to include a practice led full cycle annual audit programme and evidence of changes to practice as a result of clinical audits.
• Review risk assessment processes in regard of the changes to the branch surgery with regards to a GP not being on-site to deal with medical emergencies.

At the inspection on 7 March 2019 we found:

• Care and treatment was provided in a safe way to patients with regards to infection prevention and control including the necessary information was available regarding staff immunisation status in line with Public Health England (PHE) guidance.
• There were safe systems in place for fire safety including regular fire drills, checks for safe equipment, including calibration and mandatory training completion for staff.
• Medicines were stored safely and risk assessments for emergency medicines were in place.
• There were effective systems in place to respond to medical emergencies.
• Patients received an adequate review of their care and treatment needs on a regular basis. The practice continued to implement actions to improve the quality of care outcomes (QOF) and clinical management of long-term conditions including mental health.
• Disease registers were in place to identify and prioritise meeting patient’s needs.
• The documentation, record keeping processes and follow-up action for patient specific action taken at meetings such as safeguarding meetings and ‘huddles’ was in place.
• There was documentation to support actions taken, lessons learnt and the sharing of lessons within the practice team for significant events and complaints had occurred.
• There were effective systems and processes to ensure good governance including staffing levels, audit, the management of complaints and concerns
• Efforts to improve the uptake of cervical screen had increased the number of eligible patients participating to above 83%.

Areas where the provider should continue to develop:

• The practice should continue to resolve meeting the needs of the patients with long term conditions and with mental health concerns.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

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