This inspection was an announced focused inspection carried out on 5 July 2018 to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection between 10 and 13 July 2017.

The July 2017 comprehensive inspection was carried out in partnership with Her Majesty’s Inspectorate of Prisons (HMIP) under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions in accordance with our published methodology. CQC issued one Requirement Notice under Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 to Spectrum Community Health C.I.C. This can be found in Appendix 2 of the joint inspection report. The joint inspection report can be found at:

https://www.justiceinspectorates.gov.uk/hmiprisons/wp.../Holme-House-Web-2017.pdf

This focused inspection report covers our findings in relation to those aspects detailed in the Requirement Notice dated 5 December 2017 and findings published in the joint report. We do not currently rate services provided in prisons.

Our key findings at this focused inspection were as follows:

• The GPs gave information or reasons to patients when changes of medication were made, either in person or by letter.

• Complaints about medicines had significantly reduced since our last inspection.

• Where prisoners were issued medicines in possession, there was variable recording of appropriate assessment of the risks in patient records.

The area where the provider should make further improvements is:

In possession risk assessments should be updated where the prescriber feels the need to stop prescribing high risk tradable medicines. All prescribers should ensure they refer to recent changes when prescribing medicines in possession. Clinical records should clearly document reasons why high-risk medicines are prescribed in possession where there has been recent non-compliance or diversion of these medicines.

This inspection was an announced focused inspection carried out on 2 May 2018 to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection between 31 July and 4 August 2017.

The July – August 2017 comprehensive inspection was carried out in partnership with Her Majesty’s Inspectorate of Prisons (HMIP) under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions in accordance with our published methodology. CQC issued one Requirement Notice under regulation 12 of the Health and Social Care Act to Spectrum Community Health C.I.C. This can be found in Appendix 2 of the joint inspection report. The joint inspection report can be found at:

https://www.justiceinspectorates.gov.uk/hmiprisons/inspections/hmp-northumberland-2/

This focused inspection report covers our findings in relation to those aspects detailed in the Requirement Notice dated 21 November 2017. We do not currently rate services provided in prisons.

Our key findings were as follows:

• There was improvement in the way in which GPs managed risks associated with medicines which patients were prescribed in possession but the local policy for the completion of risk assessments was not being followed and clinical reasoning was not well documented.

• Communication around prescribing of methadone and opiate substitute therapy alongside pain relief had improved and patient records clearly documented clinical decision making.

• The GP had implemented comprehensive processes to ensure that tradable medicines were managed safely.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

Improve governance arrangements to provide adequate assurance that the service is being assessed and monitored and that improvements to the quality and safety of the service are being made including:

• Ensuring that the patient clinical record is fully complete and contemporaneous in relation to safe management and prescribing of medicines.

• Monitoring progress against action plans to improve the quality and safety of services and taking appropriate action without delay where progress is not achieved as expected.

• Working cohesively with other registered healthcare providers to ensure shared governance and audit arrangements are fully effective around areas of joint responsibility, including information from audits.

Background to One Navigation Walk

One Navigation Walk is the registered location for a range of community and prison health services provided by Spectrum Community Health C.I.C. This includes the provision of GP and pharmacy services into HMP Northumberland.

HMP Northumberland is a category C training prison which was formed in 2011 from the amalgamation of HMP Acklington and HMYOI Castington. The site covers several square miles with health services delivered from several locations across the prison. During our visit HMP Northumberland was holding around 1,340 male prisoners.

Health services at HMP Northumberland are commissioned by NHS England. The contract for the provision of GP and pharmacy services is held by Spectrum CIC. This report covers our findings in relation to those aspects detailed in the Requirement Notices issued to Spectrum CIC in November 2017. We do not currently rate services provided in prisons.

CQC inspected this location with HMIP between the 31 July and 4 August 2017. We found evidence that fundamental standards were not being met and one Requirement Notice was issued to Spectrum C.I.C. for Regulation 12, Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We subsequently asked the provider to make improvements regarding this breach. We checked these areas as part of this focused inspection and found that the provider had addressed the issues identified that fell within their control and remit, though there remained areas of governance which required further improvement.

How we carried out this inspection

This focused inspection was carried out by one CQC health and justice inspector and one CQC pharmacist specialist with guidance from a CQC GP specialist clinical advisor.

During this inspection we reviewed the action plan submitted by Spectrum to demonstrate how they would achieve compliance. We also reviewed documentary evidence including minutes of meetings, reports generated from the electronic patient clinical record system and made observations of the areas of risk identified at the last inspection. We also reviewed patient clinical records and spoke with healthcare managers, healthcare staff, the lead GP, the clinical lead for the GP service, the pharmacist and the prison governor.

We carried out an announced focused inspection of healthcare services provided by Spectrum Community Health CIC (Spectrum) at HMP and YOI Low Newton on 26 February 2019.

Following our last joint inspection with Her Majesty’s Inspectorate of Prisons (HMIP) in February 2018, we found that the quality of healthcare provided by Spectrum at this location did not meet regulations. We issued one Requirement Notice in relation to Regulation 12, Safe Care and Treatment, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The purpose of this inspection was to determine if the healthcare services provided by Spectrum were now meeting the legal requirements and regulations under Section 60 of the Health and Social Care Act 2008 and that patients were receiving safe care and treatment.

We do not currently rate services provided in prisons.

At this focused inspection we found:

• The provider had worked effectively with other health providers to ensure that medicines were prescribed and administered safely.
• The provider had made improvements to the management of medicines including ensuring patients were appropriately risk assessed when prescribed medicines.
• Prescribers clearly recorded risk assessments in patient records when they were prescribing medicines.
• Managers conducted audits of patient records to ensure that policies and procedures were being followed.