• Doctor
  • GP practice

Aston Healthcare Limited

Overall: Good read more about inspection ratings

Manor Farm Road, Liverpool, Merseyside, L36 0UB (0151) 902 0291

Provided and run by:
Aston Healthcare Limited

All Inspections

During an assessment under our new approach

Date of assessment 22 March to 15 April 2024. The inspection was prompted in part by a notification of an unexpected death of a person using the service. The information shared with CQC about the incident indicated potential concerns about the management of risk regarding medicines optimisation. This inspection examined those risks. We have rated the practice good overall. During our assessment we found systems and processes were in place to ensure safe care and treatment was provided to the practice population. However, in some circumstances risks were not fully considered and mitigated within the providers policies and procedures for medicines but, staff knew the processes undertaken.

18/11/2022

During an inspection looking at part of the service

We carried out an announced inspection at Aston Healthcare on 18 November 2022. Overall, the practice is rated as good.

Safe - not inspected

Effective – not inspected

Caring – requires improvement

Responsive – not inspected

Well-led – not inspected

Following a previous inspection in September and October 2021 the practice was rated good overall and for safe, effective, responsive and well-led. Caring was rated requires improvement.

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

Why we carried out this inspection

We carried out this inspection to follow up concerns from a previous inspection.

How we carried out the inspection

This inspection was carried out remotely and did not include a site visit.

This included:

  • Conducting staff interviews using video conferencing.
  • Requesting evidence from the provider.

Our findings

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 found that:

  • Although there was an improvement with patient satisfaction in the 2022 GP patient survey, results remained below local and national averages.
  • There had been a change in management at the practice and a development plan was in place with a focus to improve patient satisfaction and actions were being worked through at the time of inspection.
  • The provider had conducted their own patient survey in July 2022 which demonstrated an improvement in patient experience and satisfaction.

Whilst we found no breaches of regulations, the provider should:

  • Continue to complete actions identified in their improvement plan to improve the patient experience.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

23 September 2021; 27 September 2021; 28 September 2021 & 6 October 2021

During a routine inspection

We carried out an announced inspection/review (delete as appropriate) between 27 September 2021 and 6 October 2021. Overall, the practice is rated as Good.

Safe - Good

Effective -Good

Caring – Requires Improvement

Responsive - Good

Well-led - Good

Following our previous inspection on 13 November 2019, the practice was rated Requires Improvement overall and for providing safe, caring, effective and well led services. The practice was rated Good for providing responsive services.

Why we carried out this inspection/review (delete as appropriate)

This inspection was a comprehensive follow-up of information and included a site visit inspection to follow up on:

At the previous inspection the practice was in breach of Regulation 17 Good Governance. In particular systems for managing incidents were weak, systems for collecting and learning from audits and data were not in place, communication between senior managers was poor and communication between managers and operational staff was ineffective. Systems in place did not promote the safety and well-being of patients.

Areas followed up also included the recommendations made at the previous inspection.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Aston Healthcare Limited on our website at www.cqc.org.uk

How we carried out the inspection.

Throughout the pandemic CQC has continued to regulate and respond to risk. However, considering the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspection differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short site visits
  • Collaboration with Healthwatch Knowsley to seek patient feedback
  • Telephone conference with patients
  • Written feedback from staff completing CQC staff questionnaire templates.

Our findings

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 Good overall

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • 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. However, the provider needs to seek ways of improving patient satisfaction feedback scores.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality care.

Whilst we found no breaches of regulations, the provider should:

  • Ensure record keeping audits identify the actions needed to improve when results identify deficits.
  • Ensure action is taken to improve uptake of childhood immunisation.
  • Ensure action is taken to improve uptake of cervical screening.
  • Ensure health promotion discussions take place and are documented in keeping with best practice guidance, especially for people who are pre-diabetic.
  • Continue to work closely with the Patient Participate groups to increase positive feedback from patients.

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

13 November 2019 to 14 November 2019

During a routine inspection

We carried out an announced comprehensive inspection at Aston Healthcare Ltd on 13 and 14 November 2019.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 13, 14 and 15 March 2019.

The practice had made improvements since our last inspection.

  • Systems and processes had been put in place to address the requirement notices in relation to providing safe care and treatment, providing competent and well-supervised staff and medicines management.
  • Action had been taken in response to requirement notices regarding the provider’s leadership capability to deliver high quality care. However, the workflow of the leadership team needs to be reviewed.
  • Action had been taken to comply with requirement notices in relation to non-compliance in treating patients with dignity and respect and preserving their privacy; ensuring staff understood the application of the Mental Capacity Act and Deprivation of Liberty Safeguards and receiving and dealing with complaints.

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:

  • Incidents were not always well managed as some staff did not understand that these needed to be reported centrally.
  • The processes used to log incidents were unclear.
  • Investigations at a branch level were not always escalated to the provider.
  • Learning and outcomes from investigations were not always communicated appropriately.
  • Information was not recorded in sufficient detail to help identify trends.

However:

  • The practice had some newly introduced systems and processes to keep patients safe which had been reviewed and changes made as required.
  • Clinicians and receptionists had been given guidance to identify deteriorating or acutely unwell patients suffering from suspected sepsis.
  • The practice had introduced appropriate systems for the safe management of medicines.
  • The practice continued to embed newly introduced systems to promote learning and make improvements when things went wrong.

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

  • There was a significant backlog in long-term condition health reviews.
  • An effective service was not provided in relation to promoting positive outcomes for patients for example health reviews; childhood vaccines and cervical screening.

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

  • Verified feedback through NHS England patients survey and information returned through the CQC comment cards identified patient dissatisfaction with most aspects of the service.

However:

  • Unverified data from the Friends and Family test result and Healthwatch Knowsley indicated staff were kind to patients and treated them with kindness and respect.

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

  • Workforce issues meant processes for learning and continuous improvement were not fully implemented and the leaders could not demonstrate the capacity to provide the presence needed to promote sustained improvements.
  • The means by which the senior management team would achieve their goals were not clear.
  • The overall governance arrangements had not been in use long enough to allow for their effectiveness to be reviewed.
  • Although improvements were found in most aspects of risk management, the practice still did not have clear and effective processes for managing all aspects of running the six surgeries centrally.
  • The incident reporting policy and procedures in place needed strengthening.

However:

  • Leaders could show that they had the skills to deliver high quality, sustainable care.
  • Systems in place to monitor the quality of the clinical service were robust as the provider could offer assurance that clinical data collected was complete and accurate.
  • The practice demonstrated a positive culture and had systems in place to collaborate with a variety of stakeholders.

These areas affected all population groups so we rated all population groups overall as requires improvement.

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

  • The effectiveness of the new telephone system needed to be monitored.

However:

  • The practice organised and delivered services to meet patients’ needs.
  • Patients could access care and treatment in a timely way.
  • The provider responded to feedback from stakeholders and was seen to take appropriate steps and make changes promptly in response to feedback.

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:

  • Take account of staff recruitment; professional qualifications; ongoing indemnity insurance and staff immunisation status.
  • Have regard to a centralised failsafe system for monitoring cervical screening results.
  • Introduce regular health checks for patients over 75.
  • Consider introducing a standard letter to encourage parents to bring their children for immunisation and identify children who have not been brought for their vaccinations and take steps to encourage their parents to bring them for immunisation.
  • Take account of the meningitis vaccine for relevant patients.
  • Consider how best to use qualified staff to increase the uptake of cervical screening and baby vaccines.
  • Produce records from minutes that always provide useful information about what was discussed.
  • Review the processes used by the care navigators with regards consistency in guidance provided to patients.
  • Reduce the risk of private conversations being overheard at all the practices but particularly at Manor Farm.
  • Review the staff compliment of the care navigation team at busiest times of the day.
  • Review the response to patient feedback concerned with the telephone queuing system and the timeliness of repeat prescriptions.

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

13 March 2019 to 15 March 2019

During a routine inspection

We carried out an announced comprehensive inspection at Aston Healthcare Ltd on 13,14 and 15 March 2019 to follow-up on breaches of regulations identified at the previous comprehensive inspection carried out on 2,3 and 4 October 2018.

At the October 2018 inspection the practice was put into special measures, requirement and a warning notice and conditions applied in relation to the practice carrying out their regulated activities. This was because we found:

  • The registered provider had not developed an infrastructure that was sophisticated enough to effectively manage a service for 27,317 patients spread over six sites.
  • Governance arrangements for recognising and managing risks across all branches were not well established or effective.
  • Periodical health and safety checks were not always completed and when these were in place the registered provider had not responded to the recommendations in the reports. We noted that there were serious issues concerned with fire safety at three of the branch surgeries.
  • The registered provider had not ensured premises in use were fit for purpose and we found that one of the branch surgeries was unfit for use due to the condition of the premises.
  • Systems and processes in place to protect children and adults from abuse needed to be strengthened.
  • The registered providers recruitment practices did not always promote the employment of staff suitable for working with vulnerable people.
  • Processes for reporting, managing and learning from incidents were not well developed.
  • Medicines management needed to improve to ensure medicines were safe to use and administered and prescribed in keeping with the legal requirements.
  • Equipment, medicines and arrangements for dealing medical emergencies did not promote the well-being of patients.
  • The registered provider did not have oversight of the care and treatment offered to patients; there was no central control over the management, deployment or supervision of staff.
  • There was no evidence of formal performance management of GPs at the practice and a robust system of consultation, referral and prescribing audits for GPs and nurse clinicians was not in place.
  • The systems to manage complaints required improvement. There was limited evidence to show the practice encouraged and welcomed complaints so that their processes could be improved.
  • The practice acted on and learned from external safety events as well as patient and medicine safety alerts however this was not always timely.
  • Patient feedback we reviewed indicated that staff treated patients with compassion, kindness, dignity and respect, however processes and systems in place did not always support this.

At this March 2019 inspection we followed up on breaches of regulations identified, warning notices and conditions to registration.

The practice had made improvements since our last inspection.

  • Systems and processes had been put in place to address the notices of decisions in relation to providing safe care and treatment, providing competent and well-supervised staff and operating from premises which were safe and fit for purpose.
  • Action had been taken to respond appropriately to warning notices in relation to the leadership capacity and capability to deliver high quality care.
  • Action had been taken to comply with requirement notices in relation to non-compliance in treating patients with dignity and respect and preserving their privacy; ensuring staff understood the application of the Mental Capacity Act and Deprivation of Liberty Safeguards and receiving and dealing with complaints.
  • We found that improvements required in the warning notice and conditions to registration had been achieved and these conditions have been removed from the registration certificate.

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:

  • The practice had newly introduced systems and processes to keep patients safe, although it was too soon to measure their effectiveness and impact.
  • Clinicians and receptionists had not been given enough guidance on identifying deteriorating or acutely unwell patients suffering from suspected sepsis. However, they were aware of how to respond to other medical emergencies.
  • The practice did not have robust systems in place for the safe management of medicines.
  • The practice was embedding newly introduced systems to promote learning and make improvements when things went wrong.

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

  • There was monitoring of the outcomes of care and treatment however this was not always based on accurate information in that some figures used relating to the same topics differed depending on the source of information.
  • The practice could show that staff had the skills, knowledge and experience to carry out their roles, however systems in place to monitor competency was not well developed.
  • Some performance data was below local and national averages and the provider could not demonstrate that this information had been used to review practice.
  • The practice did not have a system to monitor whether treatment was always provided with the appropriate consent.

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

  • Systems in place to monitor the quality of the service were not robust or effective because the provider could not offer assurance that data collected was complete and accurate.
  • Leaders could show that they had the capacity and skills to deliver high quality, sustainable care, however these systems were new and had not been embedded.
  • The overall governance arrangements were not embedded.
  • While the practice had a clear vision, the strategy had not been ratified and implemented.
  • The practice did not have clear and effective processes for managing risks, issues and performance.
  • The practice demonstrated a positive culture which was reflected in the attitude of staff and staff satisfaction.
  • We saw evidence of systems and processes for learning and continuous improvement however these were not fully tested, and a gap was found in relation to responding to themes identified from complaints.

These areas affected all population groups so we rated all population groups overall as requires improvement.

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

  • 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.
  • Ensure persons employed in the provision of the regulated activity receive appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

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

The areas where the provider should make improvements are:

  • Consider providing practice nurses with level three child protection and adult safeguarding training.
  • Review the cleaning schedule to include small hand-held equipment.
  • Review the storage of liquids throughout the organisation.
  • Review how themes in complaints can be used to improve practice.
  • Review how complaints made by patients to stakeholders can be monitored.

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

During an inspection looking at part of the service

We carried out a comprehensive inspection of Aston Healthcare on 2,3,4 October 2018 and found the service to be inadequate over all.

This resulted in the practice being placed in special measures and imposing Conditions against the provider on 10 October 2018. We found significant breaches in Regulation 15 Premises and equipment, particularly at the Gresford Medical Centre branch. Following that inspection conditions were placed on the provider which included closure of the Gresford Medical Centre until the provider had taken steps to ensure the building and equipment was safe and fit for purpose. The Conditions advised the provider that the practice was failing to meet the required standards relating to Regulation 15 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Premises and equipment. On 20 November 2018 we undertook a focused inspection to check that the practice had met the requirements of the Conditions for Regulation 15 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found:

The provider had completed refurbishment works and the required safety checks to protect the health and safety of people who used the Gresford Medical Centre. We found the building and equipment was suitable for carrying on the registered regulated activities.

The provider had also completed additional safety checks at two other branch practices, Knowsley Medical Centre and Camberley Medical Centre.

The area where the provider should make improvements relating to this follow-up inspection only are:

Put systems in place to ensure water safety checks are documented.

The rating awarded to the practice following our full comprehensive inspection on 2, 3 and 4 October 2018 of ‘inadequate’ remains unchanged. The practice will be re-inspected in relation to the other enforcement action taken and the overall inadequate rating in the future.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

02 October to 04 October 2018

During a routine inspection

This practice is rated as inadequate overall. (Previous rating 24 November 2016– Good)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires Improvement

Are services responsive? – Requires Improvement

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Aston Healthcare Ltd on 2, 3 and 4 October 2018 as part of our risk assessed inspection programme.

At this inspection we found:

  • The registered provider had not developed an infrastructure that was sufficient enough to effectively manage a GP practice that provided a service for 27,317 patients spread across six branch surgeries.
  • Governance arrangements for recognising and managing risks across branch surgeries were not well established or effective.
  • There provider did not have systems in place to mentor or have oversight of the competencies and practice of the nurse clinicians.
  • Periodical health and safety checks were not always completed and when these were in place, the registered provider had not responded to the recommendations in the reports. We noted that there were serious issues concerned with fire safety at three of the branch surgeries.
  • The registered provider had not ensured premises in use were fit for purpose and we found that one of the branch surgeries was unfit for use due to the condition of the premises.
  • Systems and processes in place to protect children and adults from abuse needed to be strengthened.
  • The registered provider’s recruitment practices did not always promote the employment of staff suitable for working with vulnerable people.
  • Processes for reporting, managing and learning from incidents were not well developed.
  • Medicines management needed to improve to ensure medicines were safe to use, and administered and prescribed in keeping with the legal requirements.
  • Equipment and arrangements for dealing with medical emergencies did not promote the wellbeing of patients.
  • Medicines for managing medical emergencies were not always well managed.
  • The registered provider did not have oversight of the care and treatment offered to patients; there was no effective central control over the management, deployment or supervision of staff.
  • There was no evidence of formal performance management of GPs at the practice and adequate system of consultation, referral and prescribing audits for GPs and nurse clinicians was not in place.
  • The systems to manage complaints required improvement. There was limited evidence to show the practice encouraged and welcomed complaints so that their processes could be improved.
  • The practice acted on and learned from external safety events as well as patient and medicine safety alerts however this was not always timely and the provider did not have an oversight of how well alerts were responded to.
  • Patient feedback we reviewed indicated that staff treated patients with compassion, kindness, dignity and respect, however processes and systems in place did not always support this.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure staff receive training and supervision to enable them to competently carry out their roles.
  • Ensure systems are in place to ensure fit and proper persons are employed to work for the service and recruitment checks are completed before new recruits commence working at the practice. Ensure all premises and equipment used by the service provider is fit for use.

The areas where the provider should make improvements are:

  • Review the management infrastructure to ensure all aspects of running the service are covered by appropriately skilled and experienced staff.
  • Review the system for safety alerts received by the practice to ensure action taken is documented.
  • Provide clear and detailed incident reporting policies and procedures which includes periodical auditing.
  • Provide instruction and training to staff so that they understand what incidents need to be reported.
  • Develop clear and overarching systems for staff to report incidents to make sure these are responded to appropriately, learnt from and monitored.
  • Review the security of clinical waste bins that are stored outside the surgery premises.
  • Review systems for testing for commonly undiagnosed conditions.
  • Develop ways to improve uptake of cervical smears.

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 FRCGP
Chief Inspector of General Practice

24 November 2016

During a routine inspection

We carried out an announced comprehensive inspection at Aston Healthcare Limited and three of their branch surgeries 24 November 2016. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • There was an open and transparent approach to reporting and recording significant events. Risks to patients were assessed and well managed for example, arrangements to safeguard vulnerable patients, keeping medicines safe and managing infection control.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Data showed that outcomes for patients at this practice were better when compared to local and national data.

  • Feedback from patients about their care was positive. Patients said they were treated with dignity and respect and they were involved in decisions about their care and treatment.

  • Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. Staff felt well supported in their roles and had undergone a regular appraisal of their work.

  • The practice had good facilities and was equipped to treat patients and meet their needs.
  • Information about services and how to complain was available and complaint records showed an audit trail of their responses to formal complaints.
  • The practice had visible clinical leadership and governance arrangements in place.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice