Letter from the Chief Inspector of General Practice

We carried out an announced focussed inspection at HR Healthcare on 17 July 2017. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for HR Healthcare on our website at www.cqc.org.uk. This inspection was an announced focused inspection carried out on 17 July 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 22 November 2016 which led to the suspension of the service. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

• There was now an effective system in place for recording and reporting significant events.
• A system was in place to receive and act upon patient safety and medicine alerts.
• The clinical system had been updated so clinical staff could now easily access patient records from previous consultations.
• There was now a clear leadership structure in place.
• There was now a system in place for quality improvement and clinical audit.
• There was now an effective system in place to deal with emergency situations.
• Staff were aware of safeguarding procedures and a policy was in place.
• Information about making complaints was now clearly stated on the provider’s website.
• Policies and procedures were now easily accessible to staff on the intranet.
• The business continuity plan had now been updated to include relocation details.
• There was now a policy in place to cover data security, protection, destruction and disposing of sensitive data.

We previously suspended the service on 2 December 2016 for three months initially. The suspension was then extended for a further three months as the provider informed us they were still not compliant with the regulations. The service is now no longer suspended and is able to operate.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at HR Healthcare Limited between 22 November 2016 and 1 December 2016.

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

• There were no effective systems in place for recording, reporting and learning from significant events or clinical alerts.
• Risks to patients were not appropriately assessed or managed.
• Some non-clinical staff with no formal training assessed patients’ needs. Staff training was ineffective and training of clinical staff had not been assessed or monitored by the provider.
• There was no system in place that enabled staff access to patient records or information from previous consultations which made assessment and prescribing decisions reliant on the information that patients supplied.
• The service managed patients’ applications for medicines in a timely way.
• The provider used an external service (Trustpilot) to measure customer satisfaction; it was rated as 9.5 out of 10.
• Information about services was available on the provider’s website. There was no information about how to complain. The provider told us that they had received no complaints to date.
• We saw no evidence that the service worked proactively with other organisations and providers to develop services. There was little understanding of continuous improvement.
• There was no clear leadership structure or clinical leadership. The service did not proactively seek feedback from staff and patients.
• The provider was aware of the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Ensure there is a system to ensure recording, assessing and managing significant events.
• Ensure prescribing decisions are made appropriately and in line with clinical best practice and that appropriate safety advice is provided with each prescription.
• Ensure systems are in place to deal with emergency situations.
• Ensure safeguarding procedures are in place and that staff are aware of how best to identify and deal with them.
• Ensure patient identity is confirmed for each prescription and the resulting delivery of medicines is appropriate.
• Ensure that medical information displayed on HR Healthcare website(s) is clear and unambiguous.
• Ensure information about making complaints is available and that there is a system for recording, investigating and monitoring these.
• Ensure feedback from patients and staff is gathered to improve services.
• Ensure there is a clear leadership structure, with effective governance and strategies to deliver high quality care.
• Ensure policies and protocols are available to all staff.

The areas where the provider should make improvement are:

• Update the business continuity plan to include relocation and data disposal considerations.

We have suspended the registration of this provider for three months from 2 December 2016 in order to protect patients .

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice