Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr Harbidge & Partners on 6 October 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 6 October 2016 inspection can be found by selecting the ‘all reports’ link for Dr Harbidge & Partners on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 6 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

• Learning from significant events was shared with staff and six monthly significant event analysis meetings were being planned to identify common trends.

• There was an effective system in place to follow up children who did not attend hospital appointments.

• A system was in place to ensure that all medicine and equipment alerts issued by external agencies were acted upon.

• There was a system in place to ensure that patients who were prescribed high risk medicines received appropriate monitoring to minimise potential risks.

• Patients’ paper records were stored securely.

• Most staff had completed mandatory training identified by the practice.

• Governance arrangements were in place to assess and monitor risks and the quality of the service provided.

• Written and verbal complaints were recorded to enable trends to be identified.

• There were systems in place to enable the practice to receive and act on patient feedback on the quality of the service. For example, a patient participation group (PPG) had been established.

• The practice had become a dementia friendly practice.

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

The provider should:

• Ensure all GPs are up to date with mandatory training.

• Ensure that a GP who is a partner at the practice registers with the Care Quality Commission.

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 Dr Harbidge & Partners on 6 October 2016. Overall the practice is rated as requires improvement.

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

• Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

• Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

• The practice had good facilities and was equipped to treat patients and meet their needs.

• Clinical audits demonstrated quality improvement in patient outcomes.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. However, regular reviews to identify common trends had not been carried out.

• The practice had systems in place for notifiable safety incidents. However, this needed to be improved to evidence the action taken to ensure patient safety.

• Effective systems were not in place for the monitoring of patients receiving high-risk medicines.

• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment and refresher training had been arranged.

• Data showed that some patient clinical outcomes were below local and national averages, however unpublished data showed an improvement.

• Information about services and how to complain was available and easy to understand. However, verbal complaints had not been documented to help identify any common trends.

• There was a leadership structure and staff felt supported by the partners.

• Most patients said they found it easy to make an appointment with urgent appointments available on the same day.

• The results from the most recent GP national patient survey showed patients expressed higher satisfaction levels in relation to the experience of their last GP appointment and lower rates of patient satisfaction in relation to access to appointments.

• The provider was aware of and complied with the duty of candour.

• A practice matron had been appointed to support and provide a patient focused holistic service to meet the needs of housebound patients, their carers and those in local care homes. This included undertaking tailored care plans and regular health monitoring of these patients. They were able to provide acute illness advice to these patients and care homes and provide all necessary vaccinations as required for the patients who were unable to attend the surgery. Clinical issues were regularly addressed preventing patient deterioration and ongoing monitoring to prevent unnecessary acute hospital admission.

The areas where the practice must make improvements are:

• Introduce a system to follow up children who did not attend hospital appointments.

• Improve governance arrangements for assessing and monitoring risks and the quality of the service provision.

The areas where the practice should make improvements are:

• Introduce an effective system which demonstrates that all medicines and equipment alerts issued by external agencies are acted upon.

• Implement an effective the system for ensuring patients receive the necessary monitoring before prescribing high risk medicines to ensure continuing patient safety, and to minimise potential risks.

• Ensure outcomes of significant events are shared with all staff and carry out a regular analysis to identify any common trends, maximise learning and help mitigate further errors.

• Record verbal complaints to enable trends to be identified.

• Consider ways of improving the systems in place to enable the practice to receive and act on patient feedback on the quality of the service. For example, by developing the role of the patient participation group (PPG).

• Review the security arrangements for the storage of paper patient records.

• Ensure staff receive refresher training at the earliest opportunity.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

On the day of our inspection we spoke with eight patients, seven members of staff and one visiting professional. One patient told us, “Staff are very friendly. The atmosphere is good and the doctors are excellent”. Another patient told us, “I have had a very good service. I am kept well informed and they listen to my views”.

We saw that patient’s views and experiences were taken into account in the way the service was provided and that patients were treated with dignity and respect. We saw that patients experienced care, treatment and support that met their needs because they were cared for by suitably qualified, skilled and experienced staff.

We saw that patients were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines

The practice had an effective system to regularly assess and monitor the quality of the service that patients received.