The Care Quality Commission
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  • GP practice

Billinge Medical Practice

Overall: Good read more about inspection ratings

The Surgery, Recreation Drive, Billinge, Wigan, WN5 7LY (01744) 892205

Provided and run by:
Billinge Medical Practice

Important: We are carrying out a review of quality at Billinge Medical Practice. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

During an assessment under our new approach

Date of assessment: 26 September to 8 October 2024. Billinge Medical Practice is an NHS GP practice located in St Helens, Merseyside in an area of low deprivation. There were approximately 7,469 people registered with the service at the time of our assessment.

We conducted this assessment due to the service being rated as inadequate overall at our last comprehensive inspection in September 2023. At the last inspection breaches were identified in Regulation 12 Safe care and treatment and 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this assessment, we have rated the practice as good overall. We assessed 32 quality statements across the safe, effective, caring, responsive, and well-led key questions. We have combined the scores for these areas with scores from a focused assessment carried out 29 April to 13 May 2024 which took place to ensure the provider was making the required improvements to their governance systems. We found there were continued improvements to safety and governance. We saw improved systems to manage access to the service and to listen to feedback from patients and act on this. There were systems and processes in place to ensure people received effective care and treatment.

During an assessment under our new approach

We carried out a focused assessment on 29 April to 13 May 2024.

This assessment was to follow up a warning notice for breaches of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 following an inspection on 19 and 25 September 2023. We visited the practice on 13 May 2024 and spoke to staff, reviewed the premises and records. Before our visit we requested documented evidence from the practice. We assessed a total of three quality statements from the safe and well-led key questions: Safe environments, Safe and effective staffing and Governance, management and sustainability.

We found that improvements had been made and there was good practice. The scores for these areas have been combined with scores based on the key question ratings from the inspection in September 2023. Though the assessment of these three quality statements indicated good practice since the inspection in September 2023, our overall rating remains inadequate. A further assessment will take place to review the remaining quality statements and the rating.

Billinge Medical Practice is an NHS GP practice which provides primary care services to patients from one location in Wigan, Lancashire. The GP practice is registered with the Care Quality Commission under the Health and Social Care Act 2008 to provide the following regulated activities; diagnostic and screening procedures, family planning, maternity and midwifery services and treatment of disease, disorder or injury and surgical procedures. Since the inspection in September 2023 there has been a change of registered provider.

25 September 2023

During a routine inspection

We carried out an announced comprehensive inspection at Billinge Medical Practice on 19 and 25 September 2023. Overall, the practice is rated as inadequate.

Safe - inadequate

Effective - requires improvement

Caring - requires improvement

Responsive - inadequate

Well-led - inadequate

Following our previous inspection on 3, 5 and 8 August 2022 the practice was rated requires improvement for safe and well-led. There was not enough evidence to rate the effective, caring and responsive domains. This was because new partners had recently taken over the service and most staff who provided care to patients were new.

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

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection and to inspect the domains we were unable to rate at our previous inspection.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A site visit.

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:

  • The systems in place for the management of long-term conditions, patient safety alerts and high-risk medication had not consistently ensured patients had the required health monitoring.
  • Systems for ensuring risks presented by the premises were identified and addressed were not effective.
  • Training records did not demonstrate all staff had completed the training required for their roles.
  • Patient feedback indicated patients found it difficult to get through to the practice by phone and they were dissatisfied with the appointment system. The provider had made changes, however, they had not taken action to assure themselves that the changes they had introduced were having a positive effect on patient experiences. The provider did not have a system to seek, monitor and act on patient feedback and evaluate the action taken.
  • The systems for identifying, managing and mitigating some risks were not effective.

We found two breaches of regulations. The provider must:

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

We also found, the provider should:

  • Continue to gather the immunisation history for all staff employed.
  • Improve the system to ensure action plans are put in place following infection control audits.
  • Put in place a documented risk assessment to indicate the emergency medication that needs to be held and the reason.
  • Take action to check emergency medication weekly as recommended by the Resuscitation Council UK guidelines.
  • Review prescription management to enable identification of which clinician they have been allocated to.
  • Monitor Patient Group Directives to ensure prompt authorisation.
  • Introduce a system to formally document the monitoring of consultations, referrals and prescribing of clinicians.
  • Continue to monitor and improve cervical screening uptake.
  • Take action to ensure records of induction are consistently recorded.
  • Take steps to make sure information is available in easy read formats.
  • Improve record keeping for complaints to demonstrate clearly how the complainant is informed of the outcome of their complaint.

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 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.

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 Health Care

3, 5 and 8 August 2022

During a routine inspection

We carried out an announced inspection at Billinge Medical Practice on 3, 5 and 9 August 2022.

The practice is rated as requires improvement overall and for being safe and well-led.

New partners had recently taken over the service and most staff who provided care to patients were new and there was not enough evidence to rate the effective, caring and responsive domains.

We will inspect the service again within six months to provide a rating.

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

Why we carried out this inspection

We carried out this inspection to follow up concerns that were raised with us.

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 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 visit

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:

  • Not all staff had had the required training and support for their roles.
  • Communication systems and organisational culture needed to improve.
  • Systems and processes needed improving to ensure there was managerial oversight for the practice.

However:

  • The challenges faced by the provider were being addressed with external support.

We found one breach of regulation. The provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

  • Continue with transformation work to improve services to meet the needs of the patients.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

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

16 February 2017

During a routine inspection

We carried out an announced comprehensive inspection at Billinge Medical Practice on the 25 May 2016. The overall rating for the practice was good. The rating for the key question of safe was requires improvement. The full comprehensive report for the inspection

of 25 May 2016 can be found by selecting the ‘all reports’ link for Billinge Medical Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 16 February 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 25 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

After the comprehensive inspection of 25 May 2016 the practice wrote to us to say what they would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Our key findings were as follows:

  • The practice had addressed the issues identified during the previous inspection.

  • They had provided an up to date electrical certificate for the premises. They have carried out a detailed disability risk assessment.

  • They have displayed their complaints procedure which is accessible to patients and also provided a compliment and suggestion box for their patients.

  • Opening hours for the practice have been updated and displayed in both premises.

  • They have a planned maintenance programme for the premise.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

25 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Billinge Medical Practice on 25 May 2016. Overall the practice is rated as ‘Good.’

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

  • There was an open and transparent approach to reporting and recording significant events.
  • Safeguarding processes were in place and followed by staff.
  • Risks to patients were assessed and well managed, apart from those relating to the premises. The practice did not have an electrical installation certificate to show safe management of the building.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect.
  • Information about services and how to complain was available and complaint records showed good responses to formal complaints. However the policy was kept at reception and some concerns from patients on NHS choices had not been reviewed.
  • Patients were happy with improvements at the practice although some patients commented that trying to get through to the practice by phone was difficult and that they found this frustrating.
  • Some patients said they found difficulties accessing appointments but the majority were happy with improvements being made. Urgent appointments were available the same day.
  • The practice had appropriate facilities and was equipped to treat patients and meet their needs. The branch surgery needed improvements to the environment including the need of a disabled access toilet. The buildings was clean and tidy.
  • There was a clear leadership structure and staff felt supported by management. The practice acted positively in response to feedback from patients and staff.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider MUST make improvements are:

  • The registered person did not have a robust system for identifying, assessing and managing risks associated with the building. They did not provide evidence of an up to date electrical certificate for the premises to show the building was fit for purpose and safe for patient and staff use.

The areas where the provider should make improvements are:

  • They should review access and availability of the complaints procedure.

  • A risk assessment should be undertaken to ensure that all reasonable adjustments have been made to the practice for disabled people when accessing services.

  • They should update patient information including accessing open hours at the practice and branch surgery.

  • The provider should ensure that a detailed planned preventative maintenance and refurbishment plan is put into place which covers both the main practice site and their branch surgery.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

8 October 2013

During a routine inspection

Patients spoke positively about the practice and the care they received. Comments included; 'The staff are absolutely superb, they have looked after my family really well,' and 'We have always been very satisfied.'

The practice had an emergency drugs box which the practice nurse told us was checked on a monthly basis. Records confirmed this. Patients we spoke with confirmed they had time to discuss their concerns during the consultation and that treatment options were explained to them.

The practice had up to date 'child protection' and 'safeguarding vulnerable adults' policies and procedures to support staff to identify signs of abuse and take appropriate actions. This information included contact details for staff to raise concerns with the appropriate agencies.

The manager confirmed that a period of induction was arranged for new staff to support them in the first few weeks of working at the practice. The practice had a 'locum information pack'. This supported the locum GP keep up to date with any changes, for example in the practice's referral procedures and prescribing guidelines.

We looked at two significant events that occurred in the last six months and saw the changes made by the practice as a result, for example, to staff training and guidance.