Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Haeger and Partners (Previously known as Dr Roper & Partners) on 4 April 2016 where the practice was rated as good overall. However the practice was found to be requires improvement for providing safe services. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Dr Haeger and Partners on our website at www.cqc.org.uk.

As a result of that inspection we issued the practice with a requirement notice in relation to regulation risks to patient safety not been assessed and managed appropriately and safeguarding training.

This announced focussed inspection was carried on 14 June 2017 to confirm that the practice had carried out their plan to make the improvements required identified in our previous inspection on 4 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is rated as good for providing safe services.

Our key findings were as follows:

• All staff except two new staff members had received safeguarding training. The two new staff were on their induction period and at the time of the inspection were shadowing existing staff.
• The practice had undertaken a health and safety risk assessment and a fire risk assessment had been completed as required by legislation.
• The practice business continuity plan in place for major incidents such as power failure or building damage was available and had been updated with all the current contact details.
• The practice had a documented strategy and business plan to support the practice mission. This was amended when the needs of the practice changed.

At our previous inspection on 4 April 2016 we said that the practice should implement a system to identify more patients who are carers and continue to monitor and ensure improvement to national patient survey results.

At this inspection we found that the practice had still only identified 0.75% of their practice list as carers and that the practice had not monitored and reviewed the national patient survey results to ensure improvement.

Therefore the provider should

• Review process and methods for identification of carers and the system for recording this to enable support and advice to be offered to those that require it.
• Monitor and ensure improvement to national patient survey results.

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 Blackwater Medical Centre on 4 April 2016. Overall the practice is rated as good.

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

• The provider was aware of and complied with the requirements of the duty of candour.
• There was a system in place for reporting safety incidents;
• There were arrangements in place to safeguard vulnerable adults and children that reflected local guidance and national legislation. We found that not all non-clinical staff had received safeguarding training however all staff demonstrated that they were aware of their responsibilities in relation to safeguarding.
• The practice had a business continuity plan in place; some of the contact numbers were no longer valid.
• The practice had not undertaken a recent health and safety or fire risk assessment to identify, assess and mitigate the risks to the health and safety of their staff and patients.
• Staffing levels and skill mix were planned in advance and reviewed to ensure patients received safe care.
• For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice focused on helping patients understand their conditions, and signposted patients to relevant services such as Empower for patients newly diagnosed with diabetes, exercise on prescription, smoking cessation and healthy lifestyle clinics.
• There was a named GP responsible for the dispensary and all members of staff involved in dispensing medicines had received appropriate training and had opportunities for continuing learning and development. Services were tailored to meet the needs of individual patients. They were delivered in a way that promoted flexibility, choice and continuity of care.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments and that it was very difficult to get through to the practice when phoning to make an appointment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was no clear vision or strategy in place at the practice. Staff were not aware of the objectives of the practice.

The areas where the provider must make improvement are:

• Ensure all staff receive training in safeguarding and the safeguarding policy is up to date and contains relevant contact details.

• Undertake a health and safety risk assessment and a fire risk assessment as required by legislation.

The areas where the provider should make improvement are:

• Ensure all policies and procedures are reviewed routinely and updated to reflect national guidance and legislation

• Implement a system to identify more patients who are carers.

• Following implementation of new appointment system, continue to monitor and ensure improvement to national patient survey results.

• Ensure the business continuity plan is up to date and reviewed regularly.

• Consider a documented strategy and business plan to support the practice mission.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection on 17 January 2014, people we spoke with told us that staff treated them respectfully and were helpful. People told us staff were: “Always pleasant and helpful.” And: “Friendly, attentive and ready to help, really brilliant.” We saw that staff spoke politely to people and consultations were carried out in private treatment rooms. People told us they would always be seen in an emergency and normally on the same day.

Care was assessed and delivered in a way that met the needs of people who used the service. People were positive about the treatment they received from the service. One person told us: “The triage [a way of determining the severity of people’s health concerns] nurse is quite knowledgeable. I certainly feel they all know what they are doing.” And: “They’ve got to make us feel confident otherwise we worry about our care.”

Information was clearly displayed for people, including health promotion, access to support services and information about the practice and the services provided.

People told us that their treatment was clearly explained to them and they were able to ask questions and make choices about their medication. This enabled people to make informed decisions regarding their care.

During our inspection we saw from the records we looked at that appropriate staff recruitment and pre-employment checks had been carried out.

The people we spoke with were happy with the service and did not have any concerns or issues about the care and treatment they received. When any issues were raised the practice had policies and procedures in place to deal with them appropriately.