This practice is rated as Good overall. (Previous rating September 2017 – Requires Improvement)

The key questions at this inspection 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 Addison House – Haque Practice on 04 June 2018. This was to follow up on breaches of regulations and provide a new rating for all key questions and population groups.

We previously carried out a comprehensive inspection on 3rd August 2017. This was a comprehensive inspection. At that inspection, we rated the practice as requires improvement overall, with effective and caring rated as requires improvement. This was because the practice had a higher rate of exception reporting and in respect of the caring domain, the practice had not identified a sufficient number of carers. Results from the GP survey showed that patients rated the practice lower than others for some aspects of care.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. The practice had revised their reporting of significant events with a view to promoting an open, accessible and ‘no-blame’ culture. When incidents did happen, the practice learned from them and improved their processes.
• The practice did not record clinician’s immunisation status against measles, mumps and rubella (MMR) nor varicella.
• 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.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The prescribing of some antibiotics was higher than average. The practice had taken steps to improve performance.
• There were not effective systems to routinely review patients who were prescribed lithium.
• There was not an effective system to manage MHRA alerts.
• The practice reviewed the effectiveness and appropriateness of the care it provided. Some improvements had been made to the number of patients who were excepted from QOF data. Improvements had been made to identified areas of underperformance from 2016/17.
• Carers were now being identified and a carers’ champion had been appointed to signpost carers to avenues of support.
• Childhood immunisation uptake rates were now in line with the target percentage of 90% or above.
• Appraisal records were not present and available for all of the nursing team.
• The practice had improved its uptake for cervical screening. Unverified data for 2017/18 showed the number of women who had had a cervical smear in the last five years had increased to 80%.
• Weekly ‘ward rounds’ were carried out a local care home. Patients had a medicine review once a month with a GP and a CCG pharmacist.
• A number of GPs at the practice had a special interest. Internal referrals for specialist advice were made with a view to reducing hospital referrals.
• A neighbourhood clinic was held at the practice on a Saturday morning and all day on Wednesday. Clinicians saw patients from Addison House and those from another practice in the locality.
• Some feedback in the GP patient survey was low although some steps had been taken with a view to improving performance.
• Where it was identified that staff would benefit from additional training in long-term conditions, other health care professionals were invited to provide training at the weekly educational meeting.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients

The areas where the provider should make improvements are:

• Record clinician’s immunisation status against measles, mumps and rubella (MMR) and varicella and retain information to evidence the discussion during appraisal.
• Continue to review and improve patient feedback around access and the treatment provided by the nursing team.
• Ensure all appraisal records are available for inspection.
• Continue to monitor and improve performance in respect of antibiotic prescribing and exception reporting.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Addison House – Haque Practice on 3 August 2017. Overall, the practice is rated as requires improvement.

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

• Data from the national GP patient survey, published July 2017, showed patients rated the practice lower than others for some aspects of care.
• Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average. However, they had a higher than average exception reporting in some areas. Overall exception reporting for the practice was 16% compared to the CCG average of 6% and the national average of 6%.
• Childhood immunisations were carried out in line with the national childhood vaccination programme. The most recent published data for 2015/16 showed uptake rates for the vaccines given to under two year olds was lower than the national target of 90% in two areas.
• The practice had identified 134 patients as carers, which was less than 1% of the practice list size. The practice did not have a carers’ champion to help ensure that the various services supporting carers were coordinated and effective. There was no written information available to direct carers to the avenues of support available to them.
• Clinical meetings were held weekly which provided an opportunity for staff to learn about the performance of the practice. However, there were no meetings held for the reception or administration staff. Communication to this staff group was via informal discussion, email and the practice intranet system.
• A fire risk assessment had been completed; however, they did not carry out regular fire drills.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Information about services and how to complain was available.
• Patients we spoke with said they could usually make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvements are:

• Review patients monitored through QOF including patients who are subject to exception reporting for diabetes and mental health. For example, review the recall programme so that all patients are given optimal opportunity for a review.
• Monitor patient feedback through the national GP patient survey and practice surveys to continue to identify and ensure improvement to patient experience.
• Review the uptake of the childhood immunisation programme following the actions implemented to make improvements.
• Continue to identify and ensure support to carers.
• Continue to encourage patients to attend cancer screening programmes.
• Review forums to ensure effective communication to all staff.
• Carry out regular fire drills so staff are aware of how to respond in the event of a fire.

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 Addison House Surgery on 21 April 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective and responsive services, and requires improvement for providing caring services. It was also good for providing services for older people, people with long term conditions, families, children and young people, working aged people (including those recently retired and students), people whose circumstances make them vulnerable and people with mental health (including people with dementia).

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded and monitored.
• Risks to patients and staff were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Patients said they were treated with empathy, compassion, dignity and respect. Patients did not always feel that they were listened to and involved in making decisions about their care and treatment.
• Information about services and how to complain was available and easy to understand. Complaints were mostly investigated and responded to in a timely and appropriate way.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. Referrals to secondary care services were made appropriately however improvements were needed to ensure that referrals were made in a timely manner.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff were supported by management. The practice sought feedback from staff and patients. Improvements were needed to engage with patients to improve their experiences and levels of satisfaction.

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

Importantly the provider should:

• Improve the systems for monitoring learning from incidents where things go wrong to help minimise the recurrence of significant events or incidents including delayed referrals and prescription errors.
• Ensure that staff who undertake chaperone duties complete training in respect of these duties.
• Ensure that regular infection prevention control audits are carried out to test the effectiveness of infection control within the practice.
• Ensure that staff follow policies and procedures around handling and storing vaccines.
• Ensure that all complaints are responded to in line with practice policies and procedures.
• Improve systems for patient engagement and responding to concerns so as to improve patient experience and levels of satisfaction.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We inspected Addison House Practice on 04 December 2013. We found the staff to be courteous and welcoming to people visiting the practice.

We saw there were systems in place to provide people with relevant information such as notices about the practice, health promotion, safeguarding and other support services.

We received comments from twelve people who visited the practice on the day of inspection.

We saw that staff spoke politely to people and consultations were carried out in private treatment rooms.

We saw the surgery had appropriate medicines management arrangements in place.

We saw records were stores securely and could be located promptly when they were needed.

Records were kept securely and could be located promptly when they were needed