Wood Street Health Centre

We carried out an announced comprehensive inspection at Wood Street Health Centre on 25 September and 3 October 2019 to follow up on breaches of regulation identified in medicines management, clinical governance, patient satisfaction, infection control and recruitment and training processes, identified in a comprehensive inspection on 24 January 2019, where the practice was placed in special measures.

This inspection in October 2019 found that there were still improvements that were required to be made.

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

• Recruitment procedures were not effective.
• The system for monitoring and managing the two-week cancer referral process was not effective.
• There were flaws with the cold chain procedures.
• Learning from significant events was not adequately shared with relevant staff members.

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

• Quality improvement was not comprehensive.
• There was insufficient oversight of high exception reporting rates and areas of low QOF achievement.

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

• Feedback from patients was generally positive about the way staff treated people.
• The practice respected patients’ privacy and dignity.

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

• There was insufficient attention given to low patient satisfaction with access to services, which had been an ongoing concern identified by CQC in 2016.

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

• Changes made since the last inspection had not been embedded since the last inspection.
• There disjointed working between staff members.
• There was a lack of oversight in training, recruitment and governance.
• There was insufficient monitoring and management of patient satisfaction.

Whilst the practice had made improvements following their inspection in January 2019, further improvements are required. The practice therefore remains 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 previously carried out an announced comprehensive inspection of Wood Street Health Centre on 24 January 2019 and found the practice was in breach of Regulation 12: ‘Safe care and treatment’ and Regulation 17: ‘Good governance’ of the Health and Social Care Act 2008. In line with the Care Quality Commission’s (CQC) enforcement processes, we issued two warning notices which required Wood Street Health Centre to comply with the Regulations by 12 April 2019.

The full report of the 24 January 2019 comprehensive inspection can be found by selecting the ‘all reports’ link for Wood Street Health Centre on our website at www.cqc.org.uk.

We carried out this announced focused inspection on 25 April 2019 to check whether the practice had addressed the issues in the warning notices and now met the legal requirements. This report covers our findings in relation to those requirements and does not change the current ratings held by the practice.

At the inspection on 25 April 2019 we found the provider had taken action to address the requirements of the warning notices, although they were still in the process of addressing patient feedback about access to care.

Our key findings were as follows:

• Safeguarding policies and information posters had been reviewed and updated.
• Disclosure and Barring Service (DBS) checks were undertaken for all staff.
• There was evidence that the practice carried out appropriate recruitment, professional registration and indemnity checks.
• There was improved assessment and oversight of potential risks at both sites, including health and safety, fire safety, legionella and infection control.
• The practice had put in place processes to manage risks relating to test results and high risk medicines and had acted appropriately in response to findings from the previous inspection around outstanding results and instances of unsafe prescribing.
• There was oversight of the pharmacist and policies to cover any changes to patients’ medicines.
• There was a defibrillator at the branch site for use in an emergency and evidence of regular checks to ensure it was in good working order.
• The practice was effectively monitoring the refrigerator temperature at the branch site.
• The systems to review, record and act upon safety alerts and significant events were effective.
• The practice had improved oversight of the branch site through senior staff attending on a regular basis and manual transfer of updated policies and procedures from the main practice to the branch.
• Mandatory training had been completed by staff, including basic life support, fire safety, child and adult safeguarding, information governance and infection control training.
• The practice manager had received an appraisal by the lead GP.
• On the day of inspection there was no formalised action plan in place to address issues around access, although low GPPS results were due to be discussed as a full practice team and some measures had been put in place to improve access for patients.

Although there were no breaches of Regulations, we identified areas where the provider should make improvements:

• Consider the necessity for fire wardens to complete specific fire warden training.
• Ensure review dates are included on all policies and relevant information posters.
• Implement a formal action plan to improve access for patients and monitor progress.
• Ensure effective communication with building landlords to enable oversight of any risks relating to premises.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection of Wood Street Health Centre on 24 January 2019 as part of our inspection programme.

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 rated the practice as inadequate for providing safe services because:

• The practice did not have effective systems for the appropriate and safe use of medicines as we found evidence of unsafe prescribing of high risk medicines, there was no defibrillator at the branch site for use in an emergency and we identified concerns in relation to the effective monitoring of the refrigerator temperature.
• We identified 50 outstanding test results on the clinical system which the practice was not aware of, which may have left patients untreated.
• There was no written protocol or risk assessment for the pharmacist in relation to making changes to patients' medicines which identifies when GPs should be involved or consulted.
• No infection control audits had been completed at the main practice since April 2016 and at the branch site since February 2014 to ensure appropriate standards of hygiene were maintained and monitored.
• The practice had not completed its own risk assessments, such as fire, legionella or health and safety, to ensure premises were safe.
• No Disclosure and Barring Service (DBS) checks were carried out for non-clinical staff members, including those who acted as chaperones, and no risk assessment had been carried out at the time of inspection to support this decision.
• There were gaps in staff recruitment checks and ineffective systems for ongoing staff checks relating to registration and indemnity insurance.
• The system for recording and actioning safety alerts was not effective.

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

• Patients were not able to access care and treatment in a timely way.
• The practice’s GP patient survey (GPPS) results were below local and national averages for questions relating to access to care and treatment, and these results mirrored those of the practice’s own assessment questionnaire carried out in December 2018.
• Negative patient feedback about access had been identified as a concern at a previous CQC inspection in August 2016. Low GPPS results had not been discussed with staff and there was no action plan in place to address negative feedback and improve access for all patients.

These areas affected all population groups, so we rated all population groups as inadequate for responsive services.

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

• The provider had no oversight of any risk assessments completed by other parties to ensure the premises were safe, or any oversight of whether identified risks had been addressed.
• There was a lack of oversight of activities and governance at the branch site and ineffective communication between the main practice site and branch site.
• The practice did not have effective policies and processes in relation to safeguarding.
• There was no effective oversight or monitoring of staff training and we identified gaps in training.
• Significant events and complaints were recorded, however there was no formalised system to share learning with all relevant staff to ensure changes or improvements were effectively implemented.

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

• Patients’ needs were not consistently assessed, and care and treatment was not always delivered in line with current legislation, standards and evidence-based guidance.
• The systems to monitor and assess staff performance were ineffective.
• The practice was unable to demonstrate that it always obtained consent to care and treatment in line with legislation and guidance, as consent was not documented.

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

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

• Feedback from patients was generally positive about the way staff treated people.
• The practice respected patients’ privacy and dignity.

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.

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

The areas where the provider should make improvements are:

• Consider measures to encourage the uptake of childhood immunisation and cervical screening rates.
• Review the processes for recording and monitoring of consent.
• Ensure there is an effective system in place to keep clinicians up to date with current evidence-based guidelines.

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.

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 table.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice