This service is rated as Good overall. (Previous inspection January 2018 – Requires Improvement)

We previously carried out an announced, comprehensive inspection of ELM Alliance Limited on 25 January 2018 and gave an overall rating of Requires Improvement. At that inspection we identified two breaches of regulations and issued a warning notice for one of the breaches. A further inspection carried out on 13 September 2018 was an announced focussed follow-up inspection, without ratings, to check whether the provider had taken steps to comply with the legal requirements for the breach of: Regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding staffing.

The full comprehensive report on the January 2018 inspection can be found by selecting the ‘all reports’ link for Brotton Surgery – ELM Alliance on our website at www.cqc.org.uk.

The key questions are now 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 Brotton Surgery (a registered location for the delivery of extended hours and out of hours in South Tees) on 20 March 2019 as part of our inspection programme, and to follow up on a previous breach of Regulation 17 HSCA (RA) Regulations 2014 Good Governance.

At this inspection we found:

• The service had good systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
• The service 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 people with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care

This service is rated as requires improvement overall. (Previous inspection July 2017 – Inadequate)

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

We carried out an unannounced comprehensive inspection at ELM Alliance Limited on 11 and 12 July 2017. The overall rating for the service was inadequate. This service was placed in special measures in September 2017. The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link for Park Surgery – ELM Alliance Limited on our website at www.cqc.org.uk. A further focussed inspection was undertaken in November 2017, where we followed up concerns from the three warning notices we had issued. That re-inspection was not given a rating but we were satisfied that risks had been sufficiently reduced at that time.

This inspection was an announced comprehensive follow up inspection carried out on 25 January 2018 to confirm that the service had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspections.

Overall the service is now rated as Requires Improvement

Our key findings were as follows:

• The service ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated people with compassion, kindness, dignity and respect.

• Patients told us through CQC questionnaires, that they felt listened to and supported by staff and had sufficient time during consultations to make an informed decision about the choice of treatment available to them.

• Patients could access treatment and care at any time within a 24 hour period (when referred by NHS111).

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

• The provider must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

• The provider must deploy sufficient numbers of suitably qualified, competent, skilled and experienced persons, ensuring they receive appropriate support, training, professional, development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.

The areas where the provider should make improvements are:

• The provider should undertake a regular review of the staffing rota, ensuring that staffing numbers are adequate, and closely monitor absence and lateness.

• The provider should review the chaperone policy as it did not fully outline the necessary procedures and required some improvement to make it effective.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this 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 of ELM Alliance Limited on 11 July 2017 and 12 July 2017. We identified six breaches of regulations and issued warning notices for three of the breaches. This focused inspection carried out on 9 November 2017 was to check whether the provider had taken steps to comply with the legal requirements for these three breaches. The three breaches of regulation we inspected against were for:

• Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and Treatment.

• Regulation 13 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safeguarding Service Users from Abuse.

• Regulation 17: Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good Governance.

The full comprehensive report on the July 2017 inspection can be found by selecting the ‘all reports’ link for Park Surgery – ELM Alliance on our website at www.cqc.org.uk.

This inspection was an unannounced focused inspection carried out on 9 November 2017 to confirm that the service had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 11 and 12 July 2017. This report covers our findings in relation to those requirements.

Our key findings were as follows:

Improvements had been made with respect to patient safety, effectiveness and leadership following our last inspection on 11 and 12 July 2017. For example:

• New processes had been put in place to report and manage significant events and safeguarding concerns.

• Patient safety and medicines alerts were being received, assessed and when necessary, actioned appropriately.

• Improvements had been made with regard to effective governance and management within the service. For example, training and recruitment records were centrally recorded and all staff received an induction to the service.

• Health and safety risk assessments were underway.

However, there were also areas of practice where the provider needed to make improvements:

The provider must:

• Ensure that entries of medicines are correctly and fully recorded in the controlled drugs’ register.

• Check stock balances of controlled drugs on a weekly basis, in accordance with the provider’s own policy, to ensure that amounts held reflect what has been entered into the controlled drugs’ register.

• Ensure that quantities of medicines supplied are clearly indicated in records and on prescriptions.

The provider should:

• Have a system in place to check expiry dates of items on the emergency trolley.

• Replace, re-stock and re-order items which are found to have passed their expiry date, when undertaking checks of the emergency trolley.

• Document any learning points from significant events or incidents on the recording matrix used by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced, comprehensive inspection of ELM Alliance Limited on 25 January 2018. We identified two breaches of regulations and issued a warning notice for one of the breaches. This focused inspection carried out on 13 September 2018 was an announced focussed follow-up inspection, without ratings, to check whether the provider had taken steps to comply with the legal requirements for this breach of:

• Regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Staffing

This report covers our findings in relation to those requirements.

The full comprehensive report on the January 2018 inspection can be found by selecting the ‘all reports’ link for Hirsel Medical Centre – ELM Alliance on our website at www.cqc.org.uk.

Our key findings were as follows:

Overall improvements had been made with respect to the management of staffing following our last inspection on 25 January 2018. For example:

• Improvements had been made with regard to effective governance within the service. For example, training and recruitment records were centrally recorded and all staff received a corporate induction to the service.
• Supervision sessions for clinical and non-clinical staff were held on a monthly basis and records of attendance kept in a centrally managed record.
• The provider had satisfied themselves that all clinical staff had medical indemnity which covered them for the correct number of clinical sessions.
• The provider had introduced the use of a risk management tool for reporting of incidents. This had increased the effectiveness of reporting, lessons learned and feedback to staff.

On the day of inspection, 13 September 2018, the inspection team found that the provider was compliant with the breach of regulation previously identified in January 2018. (Regulation 18 Health and Social Care Act 2008(Regulated Activities) Regulations 2014: Staffing)

As this September 2018 inspection focussed only on the improvements from the issued warning notice, further comprehensive inspections of the locations, including all five key lines of enquiry, will take place in the coming months.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice