This practice is rated as Good overall. (Previous inspection of January 2017 – Requires Improvement)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Requires Improvement

Working age people (including those retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) – Good

We first inspected, Halcyon Medical Limited on 10 January 2017 as part of our comprehensive inspection programme. The overall rating for the practice was requires improvement. The full comprehensive report for the January 2017 inspection can be found by selecting the ‘all reports’ link for Halcyon Medical Limited on our website at www.cqc.org.uk. Following the inspection, the practice wrote to us to say what they would do to meet the regulations.

This inspection was an announced comprehensive inspection, carried out on 1 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified in our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection we found:

• At the previous inspection the governance arrangements needed strengthening to ensure there was regular monitoring and reviews completed. We found some of the areas previously identified had improved, however we still found gaps in the recruitment procedures. Since the inspection we have received evidence to confirm that the recruitment policy has been reviewed and the practice are in the process of actioning the concerns identified.
• Non clinical staff were carrying out chaperone duties without an assessment of risk to patients in the absence of the appropriate checks being sought. Since the inspection we have received evidence that risk assessments have been completed and DBS checks had been requested.
• The practice had assessed patients ‘needs and delivered care in line with current evidence based guidance. Since the previous inspection the practice had adapted the clinical templates to ensure their patients received regular reviews and appropriate treatment.
• The practice had also introduced focus groups made up of clinical and administration staff for each of the long term conditions. The groups met on a monthly basis to review patients on the clinical registers to ensure patients were receiving the appropriate reviews and care.
• The practice had implemented a programme of clinical audits to monitor services and demonstrate quality improvement.
• The practice had policies in place for the management of staff absence; The practice have strengthened these policies and introduced a rota to ensure there was adequate cover in all areas of the practice for the effective delivery of services.
• The practice had a system in place for the review of urgent clinical correspondence and test results; however we found examples of routine clinical correspondence that had not been actioned since November 2017.
• The practice had a system in place to identify patients that were no longer living within the local area and who could be removed from the practice list, This allowed the practice to more effectively monitor the low uptake of screening.
• The practice had implemented a system to monitor performance against childhood vaccinations. One of the practice nurses was the lead clinician in this area. The latest published data for childhood vaccinations showed the practice were below the national average; however data provided by the practice showed improvements.
• Staff understood their responsibilities to raise concerns, incidents and near misses and the practice reported all events to the local clinical commissioning group through web based incident reporting and risk management software.
• The practice ensured that care and treatment was delivered according to evidence- based guidelines. They worked with a range of health and care professionals in the delivery of patient care.
• Results from the GP national patient survey showed high levels of satisfaction in relation to consultations with GPs and nurses.
• There was a clear leadership structure and staff felt supported by management and there was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

• Continue to monitor progress against childhood vaccination programme and take action as appropriate to improve uptake.
• Monitor progress of infection control actions to ensure they are acted on.
• Assess and monitor performance against national screening programmes and clinical targets to improve outcomes for patients.

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 Halcyon Medical Limited on 10 January 2016. Overall the practice is rated as requires improvement.

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

• The practice was proactive in identifying, managing and learning from significant events, incidents and complaints.

• We saw some evidence that staff assessed patients’ 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 care and treatment. However, the practice was unable to demonstrate timely care planning to ensure appropriate treatment and optimal outcome for patients.

• The practice could not demonstrate clinical quality improvement as all audits were single cycle audits. Following the inspection the practice had submitted evidence that an osteoporosis audit had been undertaken in 2016 and this is due to be re-audited in the next five years. A miscarriage audit in April 2016 had been carried and discussed. It was agreed by the team that no changes were needed and no re-audit was necessary.

• Patients could access appointments and services in a way and at a time that suited them. The practice offered appointments with nurses and GPs on Saturdays and Sundays which was ideal for many patients who worked during normal hours.However, some patients commented that they found it difficult to get an appointment with a GP of their choice.

• There were longer appointments available for patients when needed. The practice operated a duty doctor system and telephone consultation and urgent access appointments for those with serious medical conditions.

• The practice had good facilities and was well equipped to treat patients and meet their needs. A lift was available for patients who had difficulty with their mobility.

• Patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Some areas of governance were not always effective. For example, systems and processes to support clear patient specific directions (PSDs) for the healthcare assistant to administer specific vaccinations; systems to review and update staff training and recruitment files and to ensure regular monitoring of practice performance and patient outcomes. There were no systems to review performance against childhood vaccinations. Clinical outcomes for childhood vaccination were below expected levels.

• There was a leadership structure in place however, some staff members including management staff members had been and/or were on long term leave which had an adverse effect on some aspects of the delivery of the service.

• Information about services and how to complain was available and easy to understand. Annual trend analysis of complaints was carried out and improvements made to the quality of care as a result.

The areas where the provider must make improvement are:

• Effective systems must be in place for timely care planning to ensure appropriate treatment, welfare and optimal outcomes for patients

• Healthcare assistants must have a patient specific prescription or direction from a prescriber in place to administer medicines to patients.

• The practice must strengthen governance systems and processes to proactively monitor performance and improve quality. For example, demonstrate quality improvement through at least two completed clinical audit cycles. Governance processes must be effective in delivering good quality care through appropriate monitoring of childhood vaccinations; professional registration to ensure the process for managing blank prescription forms complied with national guidance. Improve telephone access for patients to services they require and ensure staff files are up to date including staff identification and registration with their professional bodies.

• The practice must assess and mitigate risks by monitoring staffing levels to ensure appropriate cover is in place to reduce impact on the day to day management of the service.

The areas where the provider should make improvement are

• Review national GP patient survey results and explore effective ways to improve patient satisfaction.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Halcyon Medical Limited in Birmingham is a city centre GP practice with a patient population of 10,210. The practice is located inside a large high street chemist store in a modern, purpose built facility.

We found the practice was safe, effective, caring, well-led and responsive to patients’ needs. There were systems in place to learn from incidents and respond to safeguarding concerns. The practice was clean. Equipment and medication were fit for purpose and there were appropriate procedures in place to maintain this.

The services provided were designed to promote patients’ health and wellbeing. The practice worked collaboratively with other health providers to ensure this.

Patients were listened to and involved by respectful staff. There were appropriate procedures in place to include patients in their care.

Appointments were accessible and arrangements were in place to see student patients at the local university. The service acted upon patients’ comments and complaints.

An open culture and management structure meant that staff were engaged, understood their objectives and knew about decisions that affected their work. Risks to patients were managed appropriately.

During our inspection we spoke with patients and read comments they left for us. Patients said they received good care and were very positive about the staff in particular.

Organisations we contacted such as the local Clinical Commissioning Group (CCG), the General Medical Council (GMC) and the local Healthwatch had no concerns about the practice.

The practice population of 10,210 mainly consisted of working age people (city centre professionals) and students (6919 students were registered at the practice). Only 14 patients were aged 75 or over and 1418 patients identified as of Chinese origin.

We found that the practice provided specialised care plans, a named GP and targeted vaccination programmes to effectively care for older people.

The practice responded to the needs of patients with long term conditions. They operated with checked and accurate patient lists and systems of alerts and recalls to ensure patients received their care. Audits were targeted to improve patient care.

Mothers, babies, children and young people were protected because the service had appropriate systems in place to identify and report child protection concerns.

Working age people had their needs considered with the provision of appointments at set times outside of normal working hours. The practice had a number of systems in place to ensure students had their care needs met, including the provision of a surgery on the university campus during term time.

Patients whose circumstances may lead them to have poor access to primary medical services were able to register at the practice through the use of temporary resident registration.

The practice had procedures in place to assist in keeping people with mental health issues and limited understanding safe. These included a counsellor and psychologist service and referral pathways for students reporting low mood or depression.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

We carried out an announced focused inspection on 26 November 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified in our previous inspection in March 2018 where breaches of the Health and Social Care Act 2008 were identified. The practice was rated as good overall at the March 2018 inspections, however we had rated the safe key question and the families, children and young people population group as requires improvement. You can read the report from our last comprehensive inspection on 1 March 2018; by selecting the ‘all reports’ link for Halcyon Medical Limited on our website at www.cqc.org.uk. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We based our judgement of the quality of care at this service on a combination of:

• What we found when we inspected
• Information from our ongoing monitoring of data about services and
• Information from the provider, patients, the public and other organisations.

We have now rated both the safe key question and the families, children and young people population group as good as the practice has made the improvements required. This means that the practice remains rated as good overall.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• The provider had processes in place to gain assurances through relevant checks that staff were competent for their role prior to employment.
• The provider had reviewed all non clinical staff immunisation status to mitigate risk to both patients and staff.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• Staff carrying out the role of chaperoning had completed the appropriate training and received a DBS check.
• A review of the management of clinical correspondence had been completed and a quality assurance process had been implemented to ensure all letters were dealt with in a timely manner.
• The practice had commenced on a CCG initiative to improve the accuracy of clinical coding and support the GPs in the management of clinical time.
• Childhood immunisation rates continued to be lower than the national average, however the practice had implemented processes to encourage patients to attend for immunisation and the practice had seen an increase in uptake in comparison to previous years.
• The practice carried out annual infection control audits. Areas identified as requiring action were discussed with the landlords for improvement.
• The practice monitored performance against national screening programmes to improve patient outcomes.
• With the practice moving to new premises in the near future, patients had been invited to attend an event to discuss the move with the medical director and staff.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice