Archived: Horizon Healthcare Also known as Horizon Healthcare

We carried out an announced comprehensive inspection at Hina G Trivedi and Partners on 14 October 2019 to follow-up on warning notices that were issued after the previous inspection and other identified concerns identified during the previous inspection.

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.

At the previous inspection on 11 April 2019, we rated the practice as inadequate overall, in all population groups and in all key questions except for the effective key question that was rated as requires improvement and the caring key question that was rated as good. The practice was rated as inadequate in the safe, responsive and well-led key question because the practice did not have clear systems to keep patients safeguarded from abuse, patients were not always able to access care and treatment in a timely way and overall governance arrangements were ineffective, the practice had no clear systems for managing risks and leaders lacked the capacity to deliver services. The practice was rated as requires improvement in the caring key question because patient satisfaction had not been sufficiently used to make improvements, but patient satisfaction had begun to improve.

At this inspection on the 14 October 2019, we have rated this practice as requires improvement overall, in the safe, effective and well-led key questions and requires improvement for all population groups.

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

• We identified concerns relating to systems in place to ensure that medicine monitoring operated effectively, to ensure that antibiotics were prescribed within guidelines and for document management. We found that these were not always effective.
• The practice demonstrated improvements in relation to recruitment checks, safeguarding patients from abuse and in the use of significant events to learn and take action where necessary. The practice acknowledged that although actions had been taken in relation to significant events, the documentation of these actions would benefit from strengthening. Following the inspection, the practice demonstrated that they had implemented these changes.
• The practice had systems in place to safeguard patients from abuse including safeguarding registers and all staff were trained to level three, including non-clinical staff.

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

• We found that the practice was unable to demonstrate that NICE guidance was always followed and that they had lower than target cancer screening uptake rates.
• The practice demonstrated pro-active actions to address lower than target cervical screening uptake rates but were as yet unable to demonstrate that this had been effective in improving uptake.

These areas affected all population groups, so we rated all population groups as requires improvement.

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

• The practice demonstrated significant improvements in relation to overall governance arrangements since the new management structure had been installed and embedded, particularly in relation to recruitment procedures. Leaders demonstrated the capacity and skills to deliver high quality and sustainable care. However, we found concerns in relation to clinical governance arrangements in relation to adherence to NICE guidelines.

We rated the practice as g ood for providing caring and responsive services because:

• The practice demonstrated that although patient satisfaction remained low from the national GP patient survey, they had conducted their own in-house survey, whose unverified results indicated that patient satisfaction was improving in relation to being involved in their care and treatment and staff attitude. Feedback from patients that we received and reviewed on inspection indicated that there had been significant improvements in how they felt treated by staff at the practice.
• The practice demonstrated that although areas of the national GP patient survey were low in relation to access to care and treatment, they had conducted their own in-house survey, whose unverified results indicated that patient satisfaction had begun to improve. The practice had also introduced Key Performance Indicators (KPIs) for staff to answer telephone calls within three rings and regular management baseline checks to ensure that this was happening. The practice had extended surgery hours by two hours each morning of the week. Patient feedback that we received and reviewed on inspection indicated that improvements had been made, in particular in relation to access to appointments and access to the practice by telephone. The practice also had a focus on ensuring that increasing numbers of patients were signed up for online services offered by the practice, including booking appointments.

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.

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

The areas where the provider SHOULD make improvements are;

• Continue to ensure that actions taken as a result of significant events are formally documented to ensure a clear audit trail.
• Ensure that policy updates are documented to ensure a clear audit trail.
• Review patients who are receiving medicines from hospital to ensure that these medicines are documented on the clinical system in the appropriate area.

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

We carried out an announced comprehensive inspection at Hina G Trivedi and Partners on 11 April 2019.

At this inspection we followed up on breaches of regulations identified at a previous unannounced inspection on 12 June 2018, which was undertaken in response to concerns we received about management of patients with chronic conditions.

At the previous inspection we found clinicians did not have up to date and relevant information on patients to enable them to make sound clinical judgements, there was a lack of oversight of locum GP’s clinical practice and record keeping and governance systems in place were not effective. The practice was rated as inadequate and placed into special measures.

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 and for all population groups.

We rated the practice as inadequate for providing safe services because:

• Recruitment checks were not carried out in accordance with regulations.
• The practice did not have clear systems, practices and processes to keep people safe and safeguarded from abuse.
• The practice did not have an effective system in place to learn and make improvements when things went wrong. For example, all significant events were not reported and investigated.

We rated the practice as inadequate for providing responsive services because:

• Patients fed back they were not always able to access care and treatment in a timely way.
• Complaints were not used to improve the quality of care.

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

• Leaders could not show they had the capacity and skills to deliver high quality, sustainable care.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.

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

• More recent patient feedback had indicated patient satisfaction levels were improving.
• Patient satisfaction surveys had not been utilised to drive improvement.

We rated the practice as good for providing effective services because:

• The practice obtained consent to care and treatment.
• Patients’ needs were assessed and care and treatment was delivered in line with current legislation and standards.

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.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

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

This service is to remain in special measures as insufficient improvements have been made. 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.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

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