This practice is rated as Good for providing safe services. (Previous rating for Safe 07 2017 – Requires improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

We carried out an announced comprehensive inspection at Heathway Medical Centre on 26 May 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. Breaches of legal requirements were found and requirement notices were issued in relation to patient safety, receiving and acting on complaints and fit and proper persons employed. We undertook an announced comprehensive inspection at Heathway Medical Centre on 3 July 2017. The overall rating for the practice was good, however safe key question was rated requires improvement. The full comprehensive reports on the May 2016 and July 2017 inspections can be found by selecting the ‘all reports’ link for Heathway Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 2 July 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in Regulation 12 that we identified at our previous inspection on 3 July 2017. This report covers our findings in relation to those requirements and also any additional improvements made since our last inspection.

At this inspection we found:

• The practice had an effective process in place for managing un-collected prescriptions.
• We saw examples of where the practice has formalised how they shared learning from significant events with locum GPs.
• The practice was now monitoring the usage and movement of printer generated prescriptions.
• The practice nurse undertaking cervical cytology now had access to 2017/18 Sample Handling Guidelines.
• The practice had reviewed how patients with caring responsibilities were identified, this included how they were coded on the clinical system.
• Patients now had access to a wealth of information through the practice’s dedicated website.
• Steps had been taken to improve the practice’s performance in cervical cytology. Practice data reviewed suggested there has been year on year improvements.

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

We carried out an announced comprehensive inspection at Heathway Medical Centre on 26 May 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. Breaches of legal requirements were found and requirement notices were issued in relation to patient safety, receiving and acting on complaints and fit and proper persons employed. In addition we issued the practice with a warning notice for Regulation 17, Good governance, requiring them to achieve compliance with the regulation by 9 September 2016. We undertook a focused follow up inspection on 7 November 2016 to check that the practice had addressed the issues in the warning notice and found that they had met the legal requirements. The full comprehensive report can be found by selecting the ‘all reports’ link for Heathway Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 3 July 2017. Overall the practice is now rated as good.

Our key findings were as follows:

• The provider was aware of the requirements of the duty of candour. In two examples we reviewed we saw evidence the practice complied with these requirements.

• GPs liaised with the local CCG medicines management team and attended educational meetings.

• Staff had the skills and knowledge to deliver effective care and treatment.

• Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.

• Clinical audits were carried out and demonstrated quality improvement.

• Data from the Quality and Outcomes Framework showed patient outcomes were above CCG and national averages.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Information about how to complain was available and evidence from six examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

• The practice now had a governance framework which supported the delivery of their vision of highly effective care.

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

Importantly, the provider must:

• Ensure care and treatment is provided in a safe way to patients.

In addition the provider should:

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

• Consider ways of improving information available to patients, for example, a website.

• Take steps to improve the practice’s performance in cervical cytology screening.

• Review how lessons learnt from significant events and complaints are shared with the locum GP.

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 carried out an announced comprehensive inspection at Heathway Medical Centre on 26 May 2016. Breaches of legal requirements were found in relation the governance arrangements in the practice. We issued the practice with a warning notice for regulation 17, Good governance, requiring them to achieve compliance with the regulation by 9 September 2016. We found that the provider did not have effective governance processes and systems in place to keep people safe.

We undertook a focused inspection on 7 November 2016 to check that the practice had addressed the issues in the warning notice and now met the legal requirements. This report only covers our findings in relation to those requirements.

At the inspection, we found that the requirements of the warning notice had been met.

Our key findings across the areas we inspected for this focused inspection were as follows:

• The practice had made improvements since our last inspection. We found patient records were now stored in secure and lockable cupboards.
• We saw there was now a system in place for reporting and recording significant events.
• We saw clinical audits had been carried out to show patient improvements.
• We found that healthcare assistants had adopted patient specific directions (PSDs) to ensure vaccines and medicines administered by them were in line with legal guidance.
• We found that an infection control lead had been appointed and an audit had been carried out and action had been identified.
• The practice had updated several policies, including safeguarding adults and children, health and safety, mental capacity act policy, clinical governance, information governance, confidentiality and whistle blowing policy. These were now practice specific and all staff had access to them on the practice computer system.
• We found that all staff had records of Disclosure and Barring Service (DBS) checks in their personnel files as outlined in the practice recruitment policy and the practice manager was still in the process of collecting all other necessary documentation .
• The practice had initiated a patient participation group. The practice had systems in place to record and respond to complaints and we found the correspondence was documented and recorded.

The areas where the provider should make improvements are:

• Ensure systems for managing all significant events include records of details of actions taken, learning outcomes shared with staff and affected patients.
• Ensure staff files are kept up to date with recruitment checks completed, including checks with the relevant professional body.
• Ensure a formal induction programme is implemented when staff are newly appointed into the practice.
• Ensure all practice meetings are recorded and minutes are made available to all staff.

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 Heathway Medical Centre on Thursday 26 May 2016. Overall, the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment, there were no records of infection control audits, and patient notes were not stored securely.
• Staff understood their responsibilities to raise incidents, near misses and concerns. However, the practice did not have systems or processes in place to record, analyse or share learning from significant events or complaints.
• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.
• The practice had a number of policies and procedure to govern activity; however these were generic, incomplete or did not contain relevant information.
• The practice did not hold regular practice or governance meetings and issues were discussed with staff on an ad hoc basis.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• Patients told us that the appointments system was not working and they experienced long waiting times to be seen.
• Clinical staff assessed patient’s needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

The areas where the provider must make improvements are:

• Establish effective systems for managing and mitigating risks to the service, for example significant events and in relation to infection control.
• Ensure that all documents and processes used to govern activity are practice specific and are up to date. This includes safeguarding arrangements, and the use of patient specific directions when authorising clinical staff to administer vaccines.
• Ensure there is a programme to meet the learning and development needs of all staff to keep them up to date with their roles.
• Ensure recruitment arrangements include all necessary employment checks for all staff, including those outlined in Schedule 3.
• Ensure there is a programme of quality improvement activity, including clinical audits.
• Ensure systems are in place to seek and act on feedback, including complaints from patients and staff for the purpose of evaluating and improving services.

The areas where the provider should make improvement are:

• Improve processes for making appointments.
• Consider documenting discussions and decisions of all practice meetings including clinical, multidisciplinary, practice and significant events discussions to evidence the on-going care and treatment of patients and improvement of service.
• Review systems to identify carers in the practice so their needs can be identified and met.
• Develop, document and communicate to all staff the practice vision, strategy and supporting business plan and their responsibilities in relation to this.

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