This practice is rated as Inadequate overall. (Previous rating – Requires Improvement November 2017)

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Cornerstone Family Practice on 31 July 2018. This full comprehensive inspection took place following concerns found at the previous inspection resulting in a rating then of ‘Requires Improvement’ Following the inspection of November 2017 we were provided with an action plan detailing how they were going to make the required improvements. This most recent inspection was to measure the improvements made to date.

At this inspection we found:

Some areas within the practice had improved from the previous inspection in November 2017; all staff had now received some training and had access to online training modules. There had been improvements around infection control and fire safety. However, we identified that not all improvements had been made and found new concerns resulting in continuing breaches of regulation.

• The practice had a number of policies and procedures to govern activity and support the delivery of care. However, we found these processes were not monitored or reviewed in numerous areas, for example, medical alerts.
• The practice had a newly developed system to manage risk so that safety incidents were less likely to happen. However, we found this not to be consistent with clinical incidents missed and not documented or followed up.
• The practice did not routinely review the effectiveness and appropriateness of the care it provided. There was little quality assurance taking place in the practice. For example, only two very recent audits had been carried out. These were not two cycle audits and did not show that they were driving quality improvement.
• A new infection control process and policy had been established with a full practice audit completed and some of the recommendations had been actioned.
• Staff had completed some online training related to their roles and had access to online training modules. The GP had the correct level of safeguarding training in place.
• The practice had a newly formed patient participation group (PPG), which had met once.
• Staff involved and treated patients with compassion, kindness, dignity and respect.

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 the emergency equipment available at the branch surgery.
• Improve and increase the numbers of carers on the practice’s carers’ register.
• Improve staff training to ensure it is completed.

I am placing this service 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

On 31 July 2018 we carried out a full comprehensive inspection of Cornerstone Family Practice, Graham Street, Beswick Manchester,M11 3AA.

The practice was given an overall rating of Inadequate with the following domain ratings:

Safe – Inadequate

Effective – Requires improvement

Caring – Good

Responsive – Good

Well-led – Inadequate

A requirement notice was issued in respect of Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (good governance) and Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (safe care and treatment).

On 30 August 2018 warning notices were issued in respect of Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (safe care and treatment) and Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (good governance). The warning notices stated the provider must be compliant with the regulations by 29 November 2018.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Cornerstone Family Practice on our website at .

On 3 December 2018 we undertook this focused inspection to check that the practice had met the legal requirements of the warning notice. We found:

• The practice had enrolled in the Royal Collage of General Practitioners (RCGP) special measures peer support programme.
• There had been a new system introduced for reporting and recording significant events. With all staff now aware of how to act on and report events.
• There was a new process for actioning and completing medicine alerts, overseen by a clinician and clearly documented.
• GP partners had newly appointed clinical lead roles within the practice.
• There was a new clinical lead for medicine management and a policy for Hypnotic medicines was in place.
• There were multiple meetings taking place between all staff, which were minuted and had standard agenda items listed.
• The practice had discussed clinical audit but were still in the process of formulating dates into the plan.
• Registration statuses reflected the new clinical partnerships arrangement within the practice.

The rating of inadequate awarded to the practice following our full comprehensive inspection on 31 July 2018 remains unchanged. The practice will be re-inspected and their rating revised if appropriate in the future.

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

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

Letter from the Chief Inspector of General Practice

This practice is rated as requires improvement overall. (Previous inspection July 2015 – Good)

The key questions are rated as:

• Are services safe? – Requires improvement
• Are services effective? – Requires improvement
• Are services caring? – Good
• Are services responsive? – Requires improvement
• Are services well-led? - Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

• Older People – requires improvement
• People with long-term conditions – requires improvement
• Families, children and young people – requires improvement
• Working age people (including those retired and students – requires improvement
• People whose circumstances may make them vulnerable – requires improvement
• People experiencing poor mental health (including people with dementia) - requires improvement

We carried out an announced comprehensive inspection at Cornerstone Family practice on 14th November 2017.

At this inspection we found:

• The practice had a number of policies and procedures to govern activity and support the delivery of good quality care. However, we found these processes were not monitored or reviewed in multiple areas. For example, communication, staff training, HR processes, infection control and Health and Safety.
• We identified the practice reception had no face to face contact with patients on a daily basis between the hours of 12noon and 4pm.
• Staff demonstrated that they understood their responsibilities to safeguarding children and vulnerable adults; however on the day of inspection, non-clinical staff had not received training on safeguarding. The clincians safeguarding status was unknown, with the exception of the lead GP who had the information to hand durning the inspection.
• The practice had no standard internal infection control process or any record of annual audits having taken place at either site. There was no record to show whether staff were screened for or immunised against infectious diseases for example Hepatitis B.
• The branch surgery had no standard fire safety or infection control processes in place.
• Staff had not received regular training. Staff who were chaperones had not received any formal training to carry out this role or had Disclosure and Barring Service checks (DBS)or risk assessment in place.

• Clinical staff were aware of current evidence based guidance. Clinical staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

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:

• Add the full address of the Parliamentary and Health Service Ombudsman (PHSO) to the complaints policy and leaflet.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cornerstone Family Practice on the 4 June 2015.

Overall the practice is rated as good.

Specifically, we found the practice to be good for providing, safe, effective, caring, and well led services.

It was also good for providing services for the populations groups we rate.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored and reviewed.
• Risks to patients were assessed and managed.
• Patients’ needs were assessed and care was planned in line with best practice guidance.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they could make an appointment with a named GP, with urgent appointments available the same day.
• The practice was equipped to treat patients and meet their needs.
• Staff felt supported by management.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• A more robust programme of clinical audits should be developed to demonstrate positive outcomes for patients.

• Prescription pads should be securely stored.
• The lead for safeguarding should complete training to level 3.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

On the day of our inspection we were only able to speak to one patient. For some of the patients attending the morning surgery English was not their first language or they were not happy to talk to us. The patient we spoke with spoke positively about the practice and commented that they were happy with the care they received. Their comments included, “I wouldn't want to change my doctor” and “they talk everything through with you”.

We saw that all the consulting rooms were on the ground floor of the building and they were accessible to people with limited mobility. The practice was clean and there was ample seating available in the waiting area for patients. Leaflets and a television monitor in the waiting area provided patients with information about the services available.The practice leaflet also provided patents with information about how to raise a concern or complaint.

The practice had an electronic patient records system in place to record the contact patients had with the service.Procedures were in place documenting communication processes and information exchange with other healthcare professionals and services. This meant that the care of the people who use the service was coordinated.

The practice did not have an up to date recruitment policy in place.This meant that the practice could not demonstrate that it carried out effective recruitment processes. The practice ensured that all staff employed were registered with the relevant professional body.