We carried out an announced comprehensive inspection of the extended access service run by Heartbeat Primary Care Community Interest Company at various sites across Hambleton, Richmondshire and Whitby from 3 to 6 May 2022. Overall, the provider is rated as requires improvement.
Safe - Requires improvement
Effective – Requires improvement
Caring - Good
Responsive - Good
Well-led – Inadequate
Why we carried out this inspection
This announced comprehensive inspection was the provider’s first inspection. We looked at the key questions of safe, effective, caring, responsive and well-led.
How we carried out the inspection
Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections 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 via face to face and video conferencing;
- requesting feedback from staff electronically;
- requesting evidence from the provider;
- reviewing patient records to identify issues and clarify actions taken by the provider; and
- a site visit to the head office and two sites where the service is delivered from.
As part of this inspection we received feedback via face to face interview, video conference interview, discussions with staff working on-site and electronic questionnaire. This feedback came from members of the management team, clinical and non-clinical staff.
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, staff and other organisations.
We have rated this provider as requires improvement overall.
We found that:
- the provider was open and transparent about the challenges of the past year. The service had stepped-up during the pandemic to provide services and contribute to the local health agenda and work in partnership with stakeholders to deliver patient care during this time. For example, setting up COVID-19 ‘hot hub’ sites where patients with suspected COVID-19 could be seen and the delivery of the COVID-19 vaccination programme;
- there were gaps in systems to assess, monitor and manage risks to patient safety. The provider could not demonstrate fully developed safety systems were in place;
- the provider had undertaken some quality improvement activity, including clinical audit to monitor outcomes of care and treatment;
- the provider could not demonstrate effective systems and processes to ensure that staff had the skills, knowledge and experience to carry out their roles;
- staff worked together and with other health and social care professionals to deliver effective care and treatment;
- as an extended access service, the provider was not able to provide continuity of care to support patients to live healthier lives in the way that a GP practice would. Despite this the provider demonstrated their commitment to patient education and promotion of health and well-being advice;
- we observed staff treating patients with kindness, dignity and respect;
- the provider organised, considered and delivered services to meet patients’ needs. Patients could access services in a timely way;
- we found that there was a lack of oversight in key areas relating to monitoring and management of risk to patient safety and gaps in governance structures all of which had the ability to compromise the quality of care provided by the service; and
- leaders could not demonstrate they had the capacity and skills to deliver high-quality, sustainable care.
The areas where the provider must make improvements are:
- ensure that care and treatment was always delivered in a safe way for patients;
- ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties; and
- establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care