We carried out an announced comprehensive inspection at The Practice Bowling Green Street on 17 July 2019 as part of our inspection programme. At this inspection we followed up on breaches of regulations identified at a previous comprehensive inspection on 11 December 2018 and to check if sufficient improvements had been made.
We previously carried out a comprehensive inspection at The Practice Bowling Green Street in December 2018. The practice was placed into special measures as we found:
- The practice did not always have clear systems, practices and processes to keep people safe.
- The oversight and governance arrangements for the management and performance of the practice were ineffective.
- The practice did not always act on appropriate and accurate information.
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.
The practice is part of a joint venture between DHU Health Care and Leicester City Healthcare Federation which provides support with finance, governance and human resources. At this inspection, we found the provider failed to provide the necessary oversight and support to the practice.
We have rated this practice as inadequate overall.
We rated the practice as inadequate for providing safe services because:
- Recruitment checks were not carried out in accordance with regulations.
- The practice did not have clear systems, practices and processes to keep people safe and safeguarded from abuse.
- Safety alerts were not shared with all relevant staff.
- Although all staff were more involved in the significant event process, further improvements were required.
- There were gaps in systems to assess, monitor and manage risks to patient safety.
We rated the practice as inadequate for providing effective services because:
- Staff had not completed mandatory training essential to their role.
- The practice did not have regular multidisciplinary meetings to enable care to be delivered in a coordinated way.
- Verified quality and outcomes data levels were below local and national averages.
- The practice was unable to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
- Staff did not work together and with other organisations to deliver effective care and treatment.
We rated the practice as inadequate for providing well-led services because:
- Leaders could not show they had the capacity and skills to deliver high quality, sustainable care.
- The overall governance arrangements were ineffective.
- The practice did not have clear and effective processes for managing risks, issues and performance.
- The practice did not always act on appropriate and accurate information.
- The practice culture did not effectively support high quality sustainable care.
- When considering service developments or changes, the impact on quality and sustainability was assessed.
These areas affected all population groups so we rated all population groups as inadequate.
We rated the practice as requires improvement for providing caring services because:
- Patient satisfaction surveys had not been utilised to drive improvement.
- The majority of patient feedback was positive about staff and the service provided.
- Staff did not always treat patients with kindness, respect and compassion.
We rated the practice as requires improvement for providing responsive services because:
- Staff interviewed did not always have a good understanding of how to support patients with mental health needs.
- Patients fed back they were not always able to access care and treatment in a timely way as they were not able to get through to the practice by telephone.
- Although the provider was aware of negative feedback from different sources about difficulties getting through to the practice by telephone, insufficient action had been taken.
The areas where the provider must make improvements are:
- 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:
- Review carer numbers to ensure all carers are identified
This service is to remain in special measures as insufficient improvements have been made. 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