Halbutt Street Medical Practice Also known as Halbutt Street Surgery

This practice is rated as Requires Improvement overall. (Previous rating 23 October 2018 – Inadequate)

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Requires Improvement

Are services responsive? – Requires improvement

Are services well-led? – Good

The overall rating for the practice at the October 2018 inspection was inadequate and the service was placed in special measures for a period of six months. The full comprehensive report from the inspection undertaken on 23 October 2018 can be found by selecting the ‘all reports’ link for Halbutt Street Medical Practice on our website.

As a result of our findings from the October 2018 inspection CQC issued Warning Notices for the identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Specifically, we found concerns related to: safeguarding, medicines management, cervical screening, risk management including fire safety and infection control, cold chain management, staffing and recruitment and quality monitoring and improvement. The service had also not taken adequate action in response to below average national GP patient survey results. The practice was rated as inadequate and placed in special measures.

We carried out a focussed inspection on 11 February 2019 to check if improvements had been made in respect of the breaches of the regulations found during the inspection in October 2018. During that inspection we found some improvements had been made, however some breaches of the regulations remained/were found. Further warning notices were subsequently served.

The inspection on 26 June 2019 was undertaken within six months of the publication of the last comprehensive inspection. This was an announced comprehensive inspection. Overall the practice is now rated Requires improvement

At this inspection we found:

The provider had taken action and had addressed most of the concerns from the previous inspection.

For example:

• The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse.
• The practice had systems for the appropriate and safe use of medicines.
• Cancer indicators showed achievement was in line with the national and local Clinical Commissioning Group (CCG) averages. There was a failsafe process in place to manage test results.
• Safety systems and records were managed appropriately including fire safety, health and safety and infection control.
• Medicines were used and stored safely and appropriately.
• Staffing and recruitment procedures were effective.
• There was evidence of some quality improvement processes such as audits, surveys and action plans in response to areas of concern as highlighted by the results of the National GP Patient Survey.

However, we also found:

• Patient safety alerts were not always acted upon effectively.
• Above average levels of exception reporting for some diabetes indicators.
• Childhood immunisation uptake rates were below the World Health Organisation targets.
• Feedback from patients about the way staff treated people was variable.
• Support for patients for whom English was not a first language was limited.
• Feedback from patients about accessing services in a timely manner, in particular by telephone, was variable.
• Some areas of poor performance as highlighted by the results of the National GP Patient Survey had not improved.

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.

The areas where the provider should make improvements

are:

• Review the levels of antibiotic prescribing.
• Review and improve the provision of dementia training to ensure staff training requirements are identified and appropriately met.
• Review and improve available support for patients for whom English is not a first language.
• Review patient reviews online, for example on NHS Choices and consider appropriate action.
• Continue to review and improve telephone access and appointment availability at the practice.

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

This practice is rated as inadequate. (Previous rating October 2018 – Inadequate)

We carried out an announced focused inspection at Halbutt Street Medical Practice on 11 February 2019. This was to follow up on breaches of regulations set out in Warning Notices which were served on the provider on 7 November 2018. All five key questions were inspected, however only the issues identified in the Warning Notice were followed up on during this inspection. A full comprehensive inspection of this practice will follow within six months after the original comprehensive inspection on the 7 November 2018.

At this inspection we found:

• Some of the issues identified in the previous Warning Notices had been addressed, including some of those relating to infection control, patient feedback and fire safety and those relating to medicines and medical records management, staff roles, employment checks and cervical screening.
• Other issues identified had not been effectively addressed, in particular, those relating to safeguarding.
• The practice still scored below average for some areas in the national GP patient survey; specifically, regarding consultations with doctors and nurses.
• The practice informed us action had been taken to address telephone access delays and delays after patients’ appointment times were yet to produce demonstrably improved results.
• There was an inconsistent coding of patients, for example of those patients who failed to attend hospital appointments, meaning there was a risk that necessary treatment would not be followed up on.
• There was no effective policy to ensure vulnerable adults were identified and correctly coded on the clinical management system.
• There was no clear recall system for vulnerable adults with long term conditions.
• There was no effective palliative care register in place.

The areas where the provider must make improvements as they are in breach of regulations 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.

This practice will remain in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 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.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

This practice is rated as inadequate overall. (Previous rating September 2017 – Requires improvement)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection at Halbutt Street Medical Practice on 23 October 2018 to follow up the concerns identified at our previous inspection and because of concerns raised by the Clinical Commission Group (CCG). You can find the reports of our previous inspections by selecting the ‘all reports’ link on our website.

At this inspection we found action had been taken on most of the issues identified at the previous inspections. However, we found the systems in place did not keep people safe. There was a lack of governance arrangements and management oversight at the practice. The practice is now rated as inadequate.

At this inspection we found:

• The practice had succeeded in making improvements to some aspects of performance, but there were other areas that had not been addressed effectively.
• The practice still scored below the national average in the National GP Patient Survey in relation to satisfaction with both doctors’ and nurses’ consultations. The practice was aware of this and had identified themes in patient feedback and had an action plan in place to address lower scoring areas in the NHS national patient survey.
• The practice had failed to act effectively on issues with telephone access and delays after appointment time.
• There was evidence that in some areas quality improvement activity was driving improvements to patient care. At this inspection there was a record of completed audit with two cycles where the improvements made were implemented and monitored.
• The practice was not consistently following its own policies and procedures.
• The practice did not have clear systems to manage risk so that safety incidents were less likely to happen.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a culture of integrity, openness and transparency and the provider was keen to address concerns found during the inspection.

The areas where the provider must make improvements as they are in breach of regulations 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.

The areas where the provider should make improvements are:

• Improve uptake of childhood immunisations and cervical screening.
• Improve engagement with patients with diabetes.
• Consider how to record verbal complaints and actions.
• Review systems to allow patients with communication needs to access services.

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.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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