We carried out an announced focused follow up inspection at Harbourside Family Practice on 4 December 2018 as part of our inspection programme.

At this inspection, we checked to ensure that areas identified as requiring improvement from our previous comprehensive inspection in July 2018 had been addressed. We limited the inspection to the safe domain and did not review other domains or the population groups, all of which were rated as good at the last inspection. 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.

At the last inspection in July 2018 we rated the practice as requires improvement for providing safe services because:

• The provider had not ensured care and treatment was provided in a safe way to patients. Specifically, the practice vaccine fridges consistently recorded maximum temperatures in excess of the safe storage temperature.

At this inspection, we found that the provider had satisfactorily addressed these areas.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm. A comprehensive action plan had been devised the day after the July 2018 inspection and all actions had been completed within two months.

We have rated this practice as good overall and good for providing safe services.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Harbourside Family Practice is situated in the urban area of Portishead, North Somerset. It has approximately 9300 patients registered with a majority ethnicity of White British.

We undertook a comprehensive announced inspection on 24th February 2015. The overall rating for the practice was good. Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for older patients, those with long term conditions and families, children and young patients. In addition it was good for providing services for working age patients, those whose circumstances made them vulnerable and people experiencing poor mental health including those living with dementia. However, the safe domain required improvement in relation to the recruitment procedures to ensure patients are safe and their health and welfare needs are met by staff who have the qualifications, skills and experience necessary for the work to be performed. We made a requirement notice for the practice to implement the necessary changes to ensure the recruitment process was safe. We received an action plan which identified all the actions required would be in place by 30th June 2015. We visited on the 29 July 2015 to undertake a focussed inspection and to review the actions taken.

At this focussed inspection we reviewed the information contained in the staff recruitment folders and we found the practice had responded appropriately to the areas they needed to address and improvements had been made. As a result of this services were now safer for patients, staff and visitors to the practice.

Our key findings were as follows:

The practice had reviewed the recruitment files for staff and had taken remedial action to ensure they could demonstrate that staff employed for the purposes of carrying on the regulated activity were suitably qualified, skilled and experienced for their role. We found they had responded appropriately to the areas they should address and improvements had been made so services were now safer for patients, staff and visitors to the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harbourside Family Practice on 24 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing caring, responsive and effective services and for being well led. It was also good for providing services for the all the population groups. However we found that the practice required improvement for providing safe services specifically for staff recruitment.

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. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as its top priority. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including

• The practice works in an integrated way with other service providers, for example they are taking part in a pilot with the local community partnership Elderly Care and Referral Advice Service.
• The practice had implemented the ‘You’re Welcome’ quality standards for young people and had worked closely with the local schools to improve the website and presentation of health promotion information I the waiting room so as to appeal to younger patients.
• Practice staff had signed up to the ‘Dementia Friends’ initiative.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that the staff recruitment process is applied to all staff and protect patients to mitigate against the risks of the employment of unsuitable staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We were welcomed by patients and all members of staff when we visited. The inspection was announced to the service 48 hours prior to our visit. The GPs, practice manager and staff had considered a programme of events for our visit so that we had a useful variety of patients and staff to speak with. This included us attending GP/nurse consultations.

Patients were complimentary about the practice and the care and treatment they received. We saw one recent written response from a patient which stated “It gives me great pleasure to put pen to paper to congratulate your practice and the five star treatments I received from receptionist’s right through to the doctors. I want to thank one doctor in particular, for their compassion, kindness, patience and understanding, amazing and beyond their duty. I feel incredibly healthy and they have been an influence in my recovery”.

Patients experienced effective, appropriate care, treatment and support that met their needs and promoted their wellbeing. Patients felt safe and were protected from abuse or the risk of abuse because of the policies and procedures that the practice followed. Patients were safe and their health and welfare needs were met by competent staff. There was effective decision making and management of risks to patient’s health, welfare and safety. The quality of the services was monitored to help ensure best practice so that care and treatment was effective.

This practice is rated as Good overall. (Previous inspection 29 July 2015 – Good).

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at Harbourside Family Practice on 10 July 2018, as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice were aware of areas where they were performing worse than local and national averages and provided evidence to demonstrate what action had been taken and improvements made.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We found areas where the provider must make improvements:

• The provider must ensure care and treatment is provided in a safe way to patients.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice