This practice is rated as Good overall. (In November 2017, the practice was previously rated requires improvement, with good in providing safe, effective and well-led services and requires improvement in providing caring and responsive services).

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Halesowen Health Centre on 6 November 2017 as part of our inspection programme. Overall the practice was rated as requires improvement with requires improvement for providing caring and responsive services. The service was rated as good for providing safe, effective and well-led services. The full comprehensive report on the November 2017 inspection can be found by selecting the ‘all reports’ link for Halesowen Health Centre.

This inspection was an announced comprehensive inspection carried out on 22 October 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to those legal requirements and additional findings made since our last inspection.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• 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.
• The practice had a proactive approach in helping patients to live healthier lives.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients had access to care when needed but some found that the appointment system was confusing.
• Staff stated they felt respected, supported and valued and there was an open culture within the practice.
• There were clear responsibilities and roles of accountability to support good governance and management.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Consider further training for reception staff in the identification of serious medical conditions.
• Continue to explore how patient satisfaction rates can be improved.

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. We previously carried out an announced comprehensive inspection in February 2017, the practice was rated Inadequate, with the safe and well-led key questions being rated as inadequate. The practice was rated as requires improvement in effective and good in caring and responsive. We found three breaches of the legal requirements and as a result we issued a requirement notice in relation to:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Safe Care and Treatment.

• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Good Governance.

• Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Fit and Proper Persons Employed.

Following that inspection, the practice was placed in special measures.

On 6 November 2017 we carried out a full comprehensive inspection of the service to follow up and ensure that the improvements had been made to meet the regulations.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Requires Improvement

Are services responsive? – Requires Improvement

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The practice overall rating was requires improvement having been rated as requires improvement for providing caring and responsive services. These ratings apply to patients to in each of the population groups:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently 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

At this inspection we found that significant improvements had been made:

• The practice had clear systems to record, review and share learning from significant events. When incidents did happen, the practice learned from them and improved their processes.
• Health and safety arrangements had been implemented and risks to patients and staff were monitored and actions taken to minimise or mitigate risk. This included improvements in the arrangements for dealing with medical emergencies.
• There was an effective system in place to manage medicines alerts.
• The practice was able to evidence that appropriate checks had been completed on all staff employed. This included any locum staff used on an ad hoc basis.
• 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. The practice had attracted six new GP’s within the last 30 months. Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. The surgery had adopted protected learning time (PLT) during the last six months to ensure that all staff had an opportunity for both training and meetings.
• The practice had recruited a practice manager and an effective governance framework had been implemented. There was a set of policies accessible to all staff that was seen to be governing activities carried out within the practice.

There were a number of areas identified where the practice should make improvements:

• Explore how the patient feedback scores in relation to their involvement in planning and making decisions about their care and treatment can be improved.
• Further explore how the patient feedback scores in relation to access to care and treatment can be improved.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We first inspected Halesowen Health Centre on 16 February 2016. As a result of our inspection visit, the practice was rated as requires improvement. Specifically, the practice was rated as requires improvement for providing safe and caring services and a requirement notice was issued to the provider. This was because we identified regulatory breaches in relation to regulation 12 for providing safe care and treatment. Furthermore, we identified an area where the provider must make improvements and additional areas where the provider should improve.

We carried out an announced comprehensive inspection at Halesowen Health Centre one year later, on 1 February 2017. This inspection was conducted to see if improvements had been made following the previous inspection in 2016. As part of our inspection we attended the main practice based at Halesowen Health Centre and we also visited the two practice branches at Tenlands Road Surgery and Coombswood Surgery; this surgery had recently reopened on 30 January 2017 following a temporary closure period of approximately eight months. You can read the reports from our previous inspections, by selecting the 'all reports' link for Halesowen Health Centre on our website at www.cqc.org.uk.

Overall the practice is rated as inadequate. Our key findings across all the areas we inspected were as follows:

• We found that leadership and culture was weak in areas and the service lacked consistent practice management for over a year. Furthermore, patients were at risk of harm because systems and processes lacked effective management and adequate governance.

• We found gaps in the practices recruitment processes. We also found that the practices arrangements for managing medical emergencies were inadequate and operationally, we found that some systems were not monitored effectively. This was evident across many areas including emergency equipment and emergency medicines.

• When we inspected the practice in February 2016 we found gaps in the processes for disseminating and receiving national safety alerts and with regards to monitoring prescription stationery. We also identified gaps in record keeping to support fire alarm tests and evacuation drills. During our most recent inspection we found that the improvements made were not strong enough to support safe and effective systems.

• The practice could not demonstrate that locum nurses received national safety alerts. We identified two blank prescription pads amongst the emergency medicines at Tenlands Road branch surgery, indicating that the system for monitoring and tracking prescription stationery was not effective enough. Although we saw some records of fire alarm tests, this was not consistent across the three practice sites and there was no evidence of fire drills taking place.

• Although we saw that significant events were managed appropriately, there was little evidence to demonstrate how learning was effectively shared in the practice and we found that the practice did not always maximise opportunities to engage with external organisations and stakeholders such as the local Clinical Commissioning Group (CCG).

• The practice did not actively assess risk and as a result risks associated with health, safety, fire, premises and infection control were not always managed and mitigated effectively. Although we received some assurance following our inspection we found that this approach was reactive rather than proactive.

• During our previous inspection in February 2016 we found that the practice had started a programme of more frequent practice meetings. However, during our most recent inspection, we found that there was no schedule of practice team meetings taking place.

• During our inspection we saw that members of staff were courteous and helpful to patients both attending at the reception desk and on the telephone. We received positive feedback from patients regarding the service, patients said their dignity and privacy was respected and staff were described as caring and helpful.

The areas where the provider must make improvements are:

• Ensure that risks to the health and safety of service users and staff is assessed, monitored and effectively mitigated.

• Ensure that the premises and any equipment used is safe and maintained.

• Medicines, including emrgency medicines, must be supplied in sufficient quantities and managed safely to make sure people are safe.

• Ensure that recruitment procedures are established and operated effectively for staff, prior to working at the practice.

• Ensure effective governance across all areas such as policy management, infection control and prescription management; including assurance and auditing systems or processess.

• Ensure that the premises and any equipment used is clean and maintained.

• Ensure that improvements are driven in the quality and safety of the services provided and ensure that audit and governance systems remain effective.

• Systems or processes must be established to seek and act on feedback provided from relevant bodies, such as the CCG, in order to continually evaluate and improve the practice

The areas where the provider should make improvement are:

• Take a consistent approach across the three practice sites to ensure effective audit, risk and policy management is applied across the service as a whole.

• Ensure that systems and processes are appropriately transferrable to new starters such as locum nurses to support continuity and standards provided by the nursing service.

• Embed a culture of learning throughout the practice, ensure that key topics such as significant events, incidents and complaints are discussed with staff and recorded as best practice in order to share and monitor learning and action points and to continually apply improvements.

• Promote and encourage team work through a programme of formal practice meetings and encourage staff engagement across the whole practice.

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 FRCGP) 

Chief Inspector of General Practice