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:
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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.
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Communication around prescribing of methadone and opiate substitute therapy alongside pain relief had improved and patient records clearly documented clinical decision making.
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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:
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Ensuring that the patient clinical record is fully complete and contemporaneous in relation to safe management and prescribing of medicines.
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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.
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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.