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.

Details of our findings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Holbeach Medical Centre on 16 January 2019. This was as part of our inspection program.

Our judgement of the quality of care at this service is based 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.

This practice is rated as inadequate overall. (At our previous inspection on 12 August 2015 we rated the practice as good)

We rated the practice as inadequate for providing safe services because:

• Recruitment procedures did not adequately protect patients from avoidable harm and abuse.
• The prescribing of medicines to some patients did not keep them safe.
• The system for dealing with patient safety and medicines alerts was not effective.
• The practice had not taken appropriate action to address issues relating to health and safety, infection prevention control and fire safety audits.

We rated the practice as requires improvement for providing effective services because:

• Not all staff had not completed the practices mandatory training.
• Childhood immunisations rates were low for two-year olds.
• Cervical cancer screening was lower than both CCG and national averages.

This area affected all population groups so we rated all population groups as requires improvement.

We rated the practice as requires improvement for providing caring services.

• The numbers of carers that had been identified was low.
• Patient’s whose first language was not English were not provided with information in a format they could readily understand.
• There was no consistent process for supporting bereaved patients.
• There was limited opportunity for patients to discuss issues in a confidential manner.

We rated the practice as inadequate for providing a responsive service because:

• Feedback from patients relating to access to services was significantly lower when compared with local and national averages.
• Complaints information was not readily available to patients.
• The surgery was not open throughout the whole of the contracted core hours and there was no information available to patients as to what they should do when closed.
• Information to patients whose first language was not English was not provided in a format that assured they could understand.
• Feedback from patients through the national GP survey were generally lower than average. There was limited evidence of what the practice had done to address the concerns.

This area affected all population groups so we rated all population groups as inadequate.

We rated the practice as inadequate for providing well-led services because:

• There were not always clear responsibilities, roles and systems of accountability to support good governance and management.
• The practice did not always have clear and effective processes for managing risks.
• There was a back-log of new patient notes that had not been summarised, and no plans were in place to address the issue.
• Practice management was being left in the hands of an inexperienced member of staff with little support.
• The practice had been without a Registered Manger since 30 September 2018. No notification had been submitted to CQC. The application for a new Registered Manager was not submitted until 14 January.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition, the practice should also:

• Review their process for re-call of patients with long term conditions.
• Review and consider how they can increase the immunisation rates for children.
• Review and consider how they can increase the uptake of cervical cancer screening.
• Review their process for obtaining patient feedback.
• Review their process to ensure patients received information in a form they could understand.
• Review their process of identifying carers.
• Review their process to provide consistency when dealing with bereaved patients.
• Review staffing to provide support, guidance and assistance to the practice manager.

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

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at Holbeach Medical Centre on 12 August 2015. Overall the practice is rated as good. Specifically, we found the practice to be good for providing safe, effective, responsive and well-led services.

We had previously inspected this practice in October 2014 when we found that the practice required improvement in providing safe, effective, responsive and well led services.

At that inspection we also found the practice required improvements to be made in the care and treatment of older people; people with long term conditions and people whose circumstances may make them vulnerable. We found the practice to be inadequate for the population group of people experiencing poor mental health (including people with dementia).

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

• Patients were kept safe by efficient risk assessment and the thorough investigation of significant events.
• There were good procedures in place for the management of medicines.
• GPs and other clinicians regularly referred to guidelines from the National Institute for Health and Care Excellence to ensure safe and effective care of patients.
• There was effective management of the chronic illnesses and disease through systematic review of patients.
• Translation services were available for patients whose first language was not English.
• Practice policies designed to govern activity and keep people safe were relevant and regularly reviewed.
• A programme of continuous clinical and internal audit was used to monitor quality and to make improvements.
• The practice had deeply embedded values and a clear vision of the future.

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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected this service on 15 October 2014 as part of our new comprehensive inspection programme. This is the first time that we have inspected this practice.

Our key findings were as follows:

The practice GPs were very committed to their patients and understood their needs in great detail. However, the systems, policies and protocols to support this were in places lacking and confused. The electronic data base needed cleansing to ensure that patent records were correct and provided the right details to ensure that patients received the correct care and treatment according to their needs.

There was little strategic direction or transparent governance within the practice. The practice was concerned that it could not develop or expand until it was provided with a new building that would give space and an environment in which they could effectively lead and manage the day to day delivery of care and treatment for patients.

There were areas of practice where the provider needs to make improvements.

Importantly, the practice must:

• Ensure that there are governance systems and process in place to monitor and maintain the quality of the service provided to patients.
• Ensure that the data quality in patient records both electronic and paper are correct and in line with patients’ needs and medical diagnosis.
• Ensure that all risk assessments for the environment, patients and staff welfare and safety are in place and regularly reviewed.
• Ensure that all patients are regularly reviewed and where necessary have a care plan in place.
• Ensure that regular meetings take place for all staff to ensure that changes to guidance and lessons learnt through serious incident reporting and investigation are cascaded to all staff.
• Ensure that there are appropriate protocols in place to support repeat prescribing and nurse led medication reviews

In addition the provider should

• Improve access to translation services for patients whose first language is not English to ensure confidentiality and an un-biased approach to consultation.

• Ensure that the complaints policy is visible for patients and that learning is cascaded throughout the practice following the investigation of the complaint.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice