We carried out an announced focused inspection of Neath Hill Health Centre on 26 February 2019. This inspection was undertaken to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation set out in warning notice we issued to the provider in relation to Regulation 17 Good governance.

The practice received an overall rating of inadequate at our inspection on 6 November 2018 and this will remain unchanged until we undertake a further full comprehensive inspection within six months of the publication date of the initial report.

The full comprehensive report from the November 2018 inspection can be found by selecting the ‘all reports’ link for Neath Hill Health Centre on our website at .

Our key findings were as follows:

• The practice had not fully complied with the warning notice we issued but had taken some action needed to comply with the legal requirements.
• The local leaders of the practice continued to receive limited direct support from the provider organisation to ensure that governance systems were effective. However, the provider had employed the services of a consultancy firm for four weeks to support the practice in developing and improving governance systems.
• The practice had been supported by the external consultancy to develop clear systems to manage risk at the practice so that safety incidents were less likely to happen.
• Significant events and complaints were standing items on the regular practice meeting agenda to ensure areas of learning and improvement were shared with all staff.
• Systems for ensuring management oversight of staff training had been improved. All staff had received an appraisal since our inspection in November 2018.
• Policies and procedures had been established to enable the practice to operate safely and effectively. In particular, we reviewed systems for managing recruitment and found improvements had been made to ensure appropriate pre-employment checks were undertaken.
• All staff files had been reviewed and updated to ensure records were accurately maintained.
• The practice had responded to concerns identified in relation to staff immunity status for specific infections. All staff had received blood tests to identify their immunity status. However, those identified as requiring further vaccinations had not received them as stated in the practice’s risk assessments.
• There was continued evidence of poor records management as historic patient records had not been maintained in line with recognised guidance. We found there were still 114 new patient records in need of summarising.
• Staff advised that staffing levels were still insufficient as the practice had failed to recruit.

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

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. (Please refer to the enforcement section at the end of the report for more detail.)

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

This practice is rated as inadequate overall.

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Neath Hill Health Centre on 6 November 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014

At this inspection we found:

• The local leaders of the practice were poorly supported by the provider organisation to ensure that governance systems were effective. Local Leaders lacked the capacity and capability to manage the practice effectively, and practice staff advised of limited engagement of the provider organisation in the practice.
• The role and expectations of the provider and the local leaders were unclear and resulted in inadequate leadership, systems and outcomes in many aspects of patient care and safety.
• The provider did not ensure that clear systems to manage risk at the practice were in place so that safety incidents were less likely to happen.
• There was some evidence of learning and improvement through the management of significant events and complaints.
• There was no management oversight of staff training and some staff had not undertaken required training. Staff did not receive regular appraisals and there was no evidence of clinical supervision.
• Policies and procedures had not been established to enable the practice to operate safely and effectively. The management of safety systems was not evident particularly in relation to pre-employment checks and risk assessments.
• The practice reviewed the appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• There was evidence of poor records management as historic patient records had not been maintained in line with recognised guidance.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported they were able to access care when they needed it.

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. (Please refer to the requirement notice section at the end of the report for more detail).
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. (Please refer to the enforcement section at the end of the report for more detail.)

The areas where the provider should make improvements are:

• Develop a system, based on best practice, for ensuring records are kept to support appropriate dissemination and discussion of safety alerts.
• Undertake an analysis of incidents and complaints to identify trends, and to monitor and drive improvement.
• Establish a programme of regular quality improvement activities to monitor and improve standards of care.
• Continue with efforts to identify and support carers within the practice population.
• Review systems for supporting patients with poor mental health so improved clinical outcomes can be demonstrated through the Quality and Outcomes Framework.

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 FRCGPChief Inspector of General Practice

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