This practice was rated October 2018 as Requires Improvement overall.

We carried out an announced focused inspection at Buttercross Health Centre on 7 March 2019. This inspection was carried out to follow up on breaches of regulations and areas identified for improvement where we had rated the key questions of safe, effective and well led and the patient population groups of people with long-term conditions and mental health needs as requires improvement. We had implemented two regulatory requirements, Regulation 12 – Safe care and treatment and Regulation 17- Good governance and identified areas the provider should take action to improve.

These were:

Safe

The areas where the provider must improve were:

• Ensure care and treatment was provided in a safe way to patients with regards to infection prevention and control including the necessary information is available regarding staff immunisation status in line with Public Health England (PHE) guidance.
• Ensure there were safe systems in place for fire safety including regular fire drills, checks for safe equipment, including calibration and mandatory training completion for staff.
• Ensure medicines were stored safely and risk assessments for emergency medicines were in place.

The areas where the provider should make improvements were:

• Review the documentation, record keeping processes and follow-up action for patient specific action taken at meetings such as safeguarding meetings and ‘huddles’.
• Review documentation and processes to demonstrate actions taken, lessons learnt and the sharing of lessons within the practice team for significant events and complaints were in place.

Effective

Areas where the provider must improve:

• Ensure that patients received an adequate review of their care and treatment needs on a regular basis.

The areas where the provider should make improvements were:

• Continue to implement actions to improve the quality of care outcomes (QOF) and clinical management of long-term conditions including mental health.
• Review and maintain practice held disease registers such as patients who are homeless.
• Review cervical cancer screening uptake.

Well Led

• Ensure there were effective systems and processes to ensure good governance.

The areas where the provider should make improvements were:

• Review the process in place with regards to the classification of complaints and concerns and the subsequent investigation.
• Review audits to include a practice led full cycle annual audit programme and evidence of changes to practice as a result of clinical audits.
• Review risk assessment processes in regard of the changes to the branch surgery with regards to a GP not being on-site to deal with medical emergencies.

At the inspection on 7 March 2019 we found:

• Care and treatment was provided in a safe way to patients with regards to infection prevention and control including the necessary information was available regarding staff immunisation status in line with Public Health England (PHE) guidance.
• There were safe systems in place for fire safety including regular fire drills, checks for safe equipment, including calibration and mandatory training completion for staff.
• Medicines were stored safely and risk assessments for emergency medicines were in place.
• There were effective systems in place to respond to medical emergencies.
• Patients received an adequate review of their care and treatment needs on a regular basis. The practice continued to implement actions to improve the quality of care outcomes (QOF) and clinical management of long-term conditions including mental health.
• Disease registers were in place to identify and prioritise meeting patient’s needs.
• The documentation, record keeping processes and follow-up action for patient specific action taken at meetings such as safeguarding meetings and ‘huddles’ was in place.
• There was documentation to support actions taken, lessons learnt and the sharing of lessons within the practice team for significant events and complaints had occurred.
• There were effective systems and processes to ensure good governance including staffing levels, audit, the management of complaints and concerns
• Efforts to improve the uptake of cervical screen had increased the number of eligible patients participating to above 83%.

Areas where the provider should continue to develop:

• The practice should continue to resolve meeting the needs of the patients with long term conditions and with mental health concerns.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

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

This practice is rated as requires improvement overall. (Previous rating under a previous provider December 2014 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Buttercross Health Centre on 22 and 23 August 2018 as part of our inspection programme.

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 could not always demonstrate they learned from them and improved their processes.
• The practice had a plan in place to routinely review 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 patients with compassion, kindness, dignity and respect.
• They had staff vacancies however a full time GP was due to transfer to the practice nad they were actively seeking to employ clinical and non-clinical staff.
• The practice had listened and acted on patient concerns and complaints around access with a new telephone system and a central prescription hub.
• The health coaches worked with patients to help them develop confidence to manage their conditions, as well as ensuring that any liaison with other services was effective and coordinated. Patients could access the health coaches directly who coordinate care and allowed GPs to focus on the most complex patients.
• There were new policies and procedures and a system of governance which needed to have time to be fully implemented and embedded.
• There was a focus on continuous learning and improvement at all levels of the organisation.

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 with regards to infection prevention and control including the necessary information is available regarding staff immunisation status in line with Public Health England(PHE) guidance.

• Ensure there are safe systems in place for fire safety including regular fire drills, checks for safe equipment, including calibration and mandatory training completion for staff.

• Ensure medicines are stored safely and risk assessments for emergency medicines are in place.

• Ensure there are effective systems and processes to ensure good governance.

• Ensure that patients receive an adequate review of their care and treatment needs on a regular basis.

The areas where the provider should make improvements are:

• Review the documentation, record keeping processes and follow-up action for patient specific action taken at meetings such as safeguarding meetings and ‘huddles’.
• Review documentation and processes to demonstrate actions taken, lessons learnt and the sharing of lessons within the practice team for significant events and complaints are in place.
• Continue to implement actions to improve the quality of care outcomes (QOF) and clinical management of long term conditions including mental health.
• Review and maintain practice held disease registers such as patients who are homeless.
• Review the process in place with regards to the classification of complaints / concerns and the subsequent investigation.
• Review audits to include a practice led full cycle annual audit programme and evidence of changes to practice as a result of clinical audits.
• Review cervical cancer screening uptake.
• Review risk assessment processes in regard of the changes to the branch surgery with regards to a GP not being on-site to deal with medical emergencies.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice