Rishton and Great Harwood Surgery

We carried out an announced comprehensive inspection at Rishton and Great Harwood Surgery on 20 November 2019. We had previously inspected the service in April 2019, where the overall rating for the service was requires improvement. Key questions safe, and well led and population group families, children and young people were all rated requires improvement. We issued requirement notices for regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment and regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 good governance. The full report for the inspection in April 2019 can be found by selecting the ‘all reports’ link for Rishton and Great Harwood Surgery on our website at www.cqc.org.uk.

We carried out our most recent inspection in order to ensure the practice had implemented appropriate improvements.

We have rated this practice as inadequate overall.

We based our judgement of the quality of care at this service 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.

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

• The system to monitor patients with a child protection plan in place was ineffective. The practice took immediate action in response to the inspection findings.
• Systems of correspondence workflow were not sufficiently safe or effective.
• Some systems and processes to keep patients safe required improvement including the safe management of vaccines, the monitoring of medical equipment expiry dates and the provision of an antibiotic to respond in an emergency.
• Some systems to recognise opportunities to learn and make improvements when things went wrong were now in place. However opportunities to maximise learning were not always recognised.

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

• There was a lack of effective management oversight. Therefore governance arrangements to monitor and review the service provided were ineffective.
• Clear and effective processes for managing risks, issues and performance required improvement.

We rated the practice as requires improvement for providing effective services and for population groups Families, children and young people and Working age people (including those recently retired and students)

• Some performance data was below target levels, including cervical screening.
• Children who did not attend appointments were now followed up for those who missed appointments at the practice, however the same procedures were not implemented when children had not attended secondary care appointments.

We rated the practice as good for providing caring and responsive services because:

• Patients we spoke with praised the GP for the care and treatment they received.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

• Ensure patients are protected from abuse and improper treatment
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Provide clinical support and oversight for the correct monitoring for patients prescribed high risk medicines.
• Take action to assure GP awareness of the clinical equipment available and its suitability for use on children.

• Obtain evidence that locum GPs have up to date training in basic life support

• Continue to promote and develop the patient participation group.

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.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Rishton and Great Harwood Surgery on 29 April 2019. This was the first inspection of this GP practice under this registered provider. As part of this inspection we visited both the practice at Rishton and the branch surgery at Great Harwood.

The single-handed GP completed the registration of the service with the CQC in November 2018. The GP confirmed due to other issues overall management and leadership of the service did not occur fully until March 2019.

We based our judgement of the quality of care at this service 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.

We have rated this practice as requires improvement overall.

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

• Some systems and processes to keep patients safe required improvement.
• Reception staff had not been given clear guidance on identifying deteriorating or acutely unwell patients. There was lack of clarity regarding the actions to take in respect of such patients.
• Systems to recognise opportunities to learn and make improvements when things went wrong were not in place.

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

• A practice business development plan with an action plan was not available. A copy was provided after the inspection.
• Governance arrangements to monitor and review the service provided were not fully established.
• Clear and effective processes for managing risks, issues and performance required improvement.
• Systems to ensure patient information was reviewed and recorded accurately were not established.

We rated the population groups as good except for Families, children and young people which we rated as requires improvement.

• Children who did not attend appointments were not followed up.

We rated the practice as good for providing effective, caring and responsive services because:

• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

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

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Provide training to the practice cleaner.
• Undertake infection control audits and monitoring at both surgeries.
• Implement best practice guidance and obtain written consent before undertaking minor surgery.
• Undertake a data cleanse of the carer’s register to validate its content as accurate.
• Continue to promote and develop the patient participation group.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care