Billinge Medical Practice

We carried out an announced comprehensive inspection at Billinge Medical Practice on 19 and 25 September 2023. Overall, the practice is rated as inadequate.

Safe - inadequate

Effective - requires improvement

Caring - requires improvement

Responsive - inadequate

Well-led - inadequate

Following our previous inspection on 3, 5 and 8 August 2022 the practice was rated requires improvement for safe and well-led. There was not enough evidence to rate the effective, caring and responsive domains. This was because new partners had recently taken over the service and most staff who provided care to patients were new.

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

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection and to inspect the domains we were unable to rate at our previous inspection.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A site visit.

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 found that:

• The systems in place for the management of long-term conditions, patient safety alerts and high-risk medication had not consistently ensured patients had the required health monitoring.
• Systems for ensuring risks presented by the premises were identified and addressed were not effective.
• Training records did not demonstrate all staff had completed the training required for their roles.
• Patient feedback indicated patients found it difficult to get through to the practice by phone and they were dissatisfied with the appointment system. The provider had made changes, however, they had not taken action to assure themselves that the changes they had introduced were having a positive effect on patient experiences. The provider did not have a system to seek, monitor and act on patient feedback and evaluate the action taken.
• The systems for identifying, managing and mitigating some risks were not effective.

We found two breaches of regulations. The provider must:

• 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.

We also found, the provider should:

• Continue to gather the immunisation history for all staff employed.
• Improve the system to ensure action plans are put in place following infection control audits.
• Put in place a documented risk assessment to indicate the emergency medication that needs to be held and the reason.
• Take action to check emergency medication weekly as recommended by the Resuscitation Council UK guidelines.
• Review prescription management to enable identification of which clinician they have been allocated to.
• Monitor Patient Group Directives to ensure prompt authorisation.
• Introduce a system to formally document the monitoring of consultations, referrals and prescribing of clinicians.
• Continue to monitor and improve cervical screening uptake.
• Take action to ensure records of induction are consistently recorded.
• Take steps to make sure information is available in easy read formats.
• Improve record keeping for complaints to demonstrate clearly how the complainant is informed of the outcome of their complaint.

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 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.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care