Harold Road Surgery

We carried out an unannounced focused inspection at Harold Road Surgery on 15 November 2022 due to concerns reported to CQC. Overall, the practice was rated inadequate as a result of this inspection.

Safe - Inadequate

Effective – Requires improvement

Caring – not inspected, rating of good carried forward from previous inspection

Responsive – not inspected, rating of good carried forward from previous inspection

Well-led - Inadequate

Following our previous inspection on 27 June 2018, the practice was rated good overall and for all key questions. The full reports for previous inspections can be found by selecting the ‘all reports’ link for Harold Road Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up concerns reported to us.

• We inspected the following key questions: safe and key elements of the effective and well-led key questions.

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 and telephone 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 short 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:

• Safeguarding systems and processes did not always ensure patients were kept safe and protected from avoidable harm.
• Disclosure and Barring Service (DBS) checks of staff were not always undertaken.
• Recruitment checks were not always carried out in accordance with regulations.
• Staff vaccination was not maintained in line with current UKHSA guidance.
• Processes to monitor and manage infection prevention and control were not sufficiently robust.
• Arrangements for managing medicines did not ensure their safe storage.
• There were arrangements in place for the disposal of clinical and pharmaceutical waste. However, we were not assured that these were in line with national guidance.
• There was a lack of robust assessment, and provision of emergency medicines held by the practice.
• There was a lack of processes to ensure the safe management of confidential waste.
• Patients did not always receive appropriate monitoring before repeat prescriptions were issued. Prescription stationary was not held securely.
• Patients with long-term conditions were not always reviewed in line with current best practice guidance and not all patient reviews were undertaken in a timely manner.
• The practice sought to continually develop and enhance services to respond to the needs of their local population. Staff worked together and with other organisations to do so.
• The practice had sought to improve services in response to patient feedback.
• Risks to patients, staff and visitors were not assessed, monitored or managed effectively.
• Backlogs of uncompleted tasks were not appropriately managed or monitored.
• Significant events and reported concerns were not always captured or appropriately investigated and reviewed to ensure learning and improvement.
• Staff did not always feel listened to or supported when reporting concerns.
• Leaders did not have sufficient oversight of all required improvements to quality, safety and performance.
• Improvements were required to processes and systems throughout the practice to support good governance and management.
• At the time of our inspection the provider’s registration with CQC was incorrect and there was no registered manager in place.

Since the inspection the provider has sent us assurances that they have taken some action to address concerns raised. We have not verified that these actions have had impact and become embedded.

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

We wrote to the provider in February 2023 within a Section 65 letter, seeking assurance that the provider had addressed the main issues that were identified by the inspection. We have made reference to their response throughout the evidence tables.

I am placing this service into 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.

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 Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Healthcare