We previously carried out an announced comprehensive inspection at Strelley Health Centre in May 2017. The overall rating for the practice was inadequate.

We carried out a focused inspection in December 2017 to confirm that the practice had taken the required action to meet the legal requirements in relation to the breaches in regulation set out in warning notices issued to the provider following our May 2017 inspection. The warning notices were issued in respect of breaches of regulation related to safe care and treatment, staffing and good governance.

The full reports from the previous inspections can be found by selecting the ‘all reports’ link for Strelley Health Centre on our website at www.cqc.org.uk.

This inspection was a comprehensive inspection with a site visit undertaken on 7 March 2018. Strelley Health Centre is one of four locations of the provider ‘The Beechdale Medical Group’. All four locations registered to the provider were inspected between 22 February 2018 and 7 March 2018. The overall rating for this location is requires improvement.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Requires improvement

Are services responsive? – Requires improvement

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 – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) - Requires improvement

Our key findings were as follows:

• The practice had implemented clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. Robust recording systems had been introduced to ensure significant events were monitored and reviewed.
• Arrangements to respond to emergencies had been significantly improved; arrangements had been standardised across the practice group.
• Regular risk assessments were undertaken in respect of premises health and safety issues. Appropriate action had been taken by the practice in response to ongoing premises issues outside of the practice’s control.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Bowel and breast cancer screening rates were slightly below local and national averages.
• Staff were supported to access the training required to fulfil their roles and received regular appraisals.
• We observed that staff involved and treated patients with compassion, kindness, dignity and respect; however GP patient survey results reflected poor patient satisfaction in respect of GPs at the time of the survey in January 2017.
• There were increased appointments and clinical capacity since our last inspection; however, changes had not yet been reflected in patient survey results.
• Leadership arrangements had been reviewed and improved across the practice group; this included the recruitment of a new business manager to provide strategic and operational leadership; a practice manager for this location and a nurse clinical quality lead.
• There were clear plans in place to improve the quality of services provided for patients; including through a rebuild of the premises.

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

The provider should:

• Continue to review and improve patient satisfaction with regards to care and treatment and access to appointments.
• Continue to improve methods for identification of carers and the system for recording this to enable support and advice to be offered to those that require it.
• Continue to review and improve uptake rates for cancer screening.
• Continue to review and improve the use of the clinical system to ensure all tasks are managed appropriately.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Strelley Health Centre on 11 May 2017 and 23 May 2017. The overall rating for the practice was inadequate. The full comprehensive report from May 2017 can be found by selecting the ‘all reports’ link for The Strelley Health Centre on our website at www.cqc.org.uk.

The overall rating of inadequate will remain unchanged until we undertake a further full comprehensive inspection of the practice within the six months of the publication date of the report from May 2017.

This inspection was a focused inspection carried out on 1 December 2017 to confirm that the practice had taken the required action to meet the legal requirements in relation to the breaches in regulation set out in warning notices issued to the provider. The warning notices were issued in respect of breaches of regulation related to safe care and treatment and good governance.

Our key findings were as follows:

• The practice had complied with the warning notices we issued and had taken the action needed to comply with legal requirements.
• Arrangements to handle emergencies had been improved.
• New systems had been introduced to ensure staff were provided with the training relevant to their role. Clinical staff had received comprehensive appraisals.
• Systems to identify, monitor and mitigate risk had been improved.
• Systems to monitor access to appointments had been improved and there was additional GP capacity.

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 Strelley Health Centre on 11 May 2017 and 23 May 2017. Overall the practice is rated as inadequate.

Strelley Health Centre is a registered location under the provider, The Beechdale Medical Group. All of the provider's four registered locations were inspected on 11 and 23 May 2017; all four locations have been rated inadequate for the well-led domain.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, the practice had not addressed identified concerns with infection control and electrical safety.
• The risk to patients had not always been identified and addressed. For example there was no fire risk assessment specific to the areas of the building in which the practice provided services.
• Clinical audits were undertaken across the practice group. We saw evidence of improved care for patients following a recall of patients where issues had been identified.
• The practice had limited systems to keep clinicians up to date with national guidelines and guidance.
• Although we saw evidence that action was taken in response to MHRA alerts across the practice, we were not assured that there were effective systems in place to ensure staff working at this practice were kept informed about alerts.
• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.
• Staff had not received regular appraisals; however, plans were in place to undertake appraisals.
• Not all staff had received the training required for them to perform their roles effectively and safely.
• The provider had not ensured that healthcare assistants were administering medicines within the legal framework allowing them to do so.
• Appointment systems were not always operated effectively so patients did not always receive timely care when they needed it.
• Staff did not always demonstrate a commitment to patient confidentiality.
• The practice had a leadership structure but we were not assured that there was sufficient leadership capacity and there were limited formal governance arrangements.
• The majority of patients who responded to CQC comments cards said they were treated with compassion, dignity and respect.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way; including arrangements for responding to emergencies and the proper and safe management of medicines
• Ensure systems are operated effectively to assess, monitor and mitigate risk. This includes addressing identified concerns with infection prevention and control, fire risk and arrangements to manage incidents and significant events
• Ensure systems are in place to keep clinical staff up to date with national guidance and local guidelines.
• Ensure systems are operated effectively to respond to complaints
• Ensure suitable numbers of staff are deployed to meet the needs of patients and that staff are provided with training and supervision required to meet the scope of their role.
• Ensure that Statutory Notifications stipulated in the CQC (Registration) Regulations 2009 are submitted within the required timeframe.

The practice should:

• Improve the identification and review of carers
• Improve systems to provide patients with learning disabilities with annual reviews
• Review and act upon internal and external patient survey data

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