Background to this inspection
Updated
20 October 2021
Julian House Homeless Health Service is located in Bath at:
Julian House
Manvers Street
Bath
BA1 1JW
Julian House Homeless Health services have been delivered by the provider, Heart of Bath since April 2018. It is a GP practice specifically commissioned to provide access to healthcare for the homeless within the Bath and North East Somerset area. The vision and aim of the practice are to move patients onto mainstream GP practices once they had stabilised their lives and housing requirements. At the time of the inspection the practice had approximately 50 patients registered, and these included some temporary residents.
Enhanced infection prevention and control measures were put in place since the pandemic and in line with the national guidance. The homeless health service continued to provide face to face GP and nursing appointments due to the vulnerability of people using the service. Patients were asked to wear a mask, staff wore personal protective equipment and maintained social distancing where possible.
The service is co-located within the Julian House Homeless Hostel. The location provides a walk-in service for patients from 9.30 am – 2.30 pm Tuesday, Wednesday and Thursday and 9.30 am to 1.30 pm on Mondays and Fridays. Outside of these times patients were advised to call NHS 111 by the homeless hostel staff who were on site 24 hours a day and could provide support to patients in contacting the service.
The practice is registered to provide the following regulated activities; Treatment of disease, disorder or injury; family planning; diagnostic and screening procedures; maternity and midwifery services, and surgical procedures.
Further information about the practice can be found obtained through their website at:
www.heartofbath.com
Updated
20 October 2021
We carried out an announced inspection at Julian House Homeless Health Service on 4 August 2021. Overall, the practice is rated as Good.
Safe - Good
Effective - Good
Caring - Good
Responsive – Good (carried over from last inspection)
Well-led – Good
At our previous inspection on 2 May 2019 the practice was rated Requires Improvement overall and for the Caring and Well-led key questions. The key questions Safe, Effective and Responsive were rated as Good.
The full reports for previous inspections can be found by selecting the ‘all reports’ link for Julian House Homeless Health Service on our website at www.cqc.org.uk
Why we carried out this inspection
This was a follow-up inspection, incorporating remote searches and interviews of staff and a site visit to follow up on:
- Key questions inspected were Safe, Effective, Caring and Well-led
- Areas followed up including any breaches of regulations or ‘shoulds’ identified in previous inspection
- Ratings for responsive were carried forward from previous inspection.
How we carried out the inspection
Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.
This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.
This included:
- Conducting staff interviews using video conferencing
- Completing clinical searches on the practice’s patient records system and discussing findings with the provider
- Reviewing patient records to identify issues and clarify actions taken by the provider
- Requesting evidence from the provider
- A short site visit
- Obtaining feedback from other stakeholders.
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 have rated this practice as Good overall and Good for the population group: people whose circumstances make them vulnerable and those experiencing poor mental health. The service had no patients registered in the other population groups, older people and families, young people and children, which meant these were not rated. In the population groups, people with long term conditions and working age people (including those recently retired and students) there were not enough patients registered to make a judgement, which meant these groups were also not rated.
We found that:
- Improvements had been implemented and were embedded in practice, including privacy and dignity of patients, obtaining their feedback and quality improvement audits.
- The practice provided care in a way that kept patients safe and protected from avoidable harm.
- Patients received effective care and treatment that met their needs.
- Privacy screening had been fitted since the last inspection in the treatment room to maintain patient dignity.
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
- There was now a system for patients to give feedback and be actively involved in ongoing development of the service, for example a planned extension of reproductive health services.
- The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
- There was a cohesive team of staff who were strong advocates for improving the quality of life and health of homeless people.
- The way the practice was led and managed promoted the delivery of a high-quality, person-centre care. Quality improvement initiatives such as non-clinical and clinical audits and research were carried out across the organisation and findings were shared with the team.
- Patients with long term conditions were encouraged to register with the mainstream provider and therefore included in clinical audits run there. An example we saw provided assurance of accurate identification, care and treatment of any patients with chronic kidney disease.
We also found the following area of notable practice:
- The service led a successful COVID-19 vaccination programme across the city of Bath targeting hard to reach people experiencing homelessness. In total, 83% of patients receiving the first dose, were able to receive the second dose due to the high level of engagement, education and flexibility of the programme delivered by staff.
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
Working age people (including those recently retired and students)
Insufficient evidence to rate
Updated
20 October 2021