Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Hutchings and Partners (Rosemead Surgery) on 27 April 2016. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, to report incidents and near misses, and action was taken to improve safety. Documentation of significant events was not always thorough and learning was not always shared with the multidisciplinary team in line with the practice policy. Annual review of significant events did not take place to enable identification of trends.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not always implemented well enough to ensure patients were kept safe. For example, there were not adequate processes for mitigating and reviewing risks relating to fire safety, gas safety, training, and portable electrical appliance testing.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance and delivered effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• The practice had not taken all steps to ensure that it was accessible to people with restricted mobility, hearing difficulties, and who did not speak English.
• The practice had a number of policies and procedures to govern activity, but some were not followed.
• There was a committed and hardworking team of staff leading the practice. The practice were committed to delivering high quality care and promote good outcomes for patients.

The areas where the provider must make improvements are:

• Introduce robust processes to ensure significant events are fully recorded, analysis of trends takes place, and ensure learning is shared with all appropriate staff.
• Ensure appropriate actions are taken to mitigate risks relating to fire and gas safety.
• Ensure portable electrical appliance testing is carried out.

• Ensure that all staff training is up to date.

The areas where the provider should make improvements are:

• Take steps to enable patients with disabilities, hearing difficulties, and whose first language is not English to access the surgery services more easily.
• Ensure documentation of formal references.

• Review exception reporting and ensure patients receive appropriate care and treatment within national guidelines for exception reporting.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Dr Hutchings and Partners on 27 April 2016. The practice was rated as requires improvement for providing safe care and well led services and good for being effective, caring and responsive. The practice was rated as requires improvement overall. This was because we found that there was not always clear documentation of significant events or of the meetings where these were discussed; the practice’s significant events policy was not followed and not all staff attended the meetings. The practice did not carry out annual reviews of significant events to identify trends. In addition, there was not always adequate monitoring and mitigation of risks relating to fire, gas and electrical appliance safety. It was also found that the monitoring of training was weak, and not all staff had completed up to date training relevant to their roles, such as safeguarding children and adults, health and safety and infection control.

Following the inspection we asked the provider to send a report of the changes they would make to comply with the regulations they were not meeting at that time in relation to significant events, premises safety and staff training.

In addition to the regulation breach, during the inspection in April 2016, we made recommendations of best practice to address some minor areas of concern. Whilst the practice was rated as good for providing effective and responsive services, we recommended that the practice reviewed its decision making process for exception reporting of some patients with long-term conditions. (Exception reporting is the removal of patients from Quality and Outcomes Framework calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). We also recommended that they took steps to enable patients with disabilities, hearing difficulties and those whose first language is not English, to access the surgery services more easily.

We carried out a desktop inspection of Dr Hutchings and Partners in December 2016 to assess whether the practice had made the recommended improvements. We found the practice was able to demonstrate that they were meeting the standards for safe care and well led services. In particular;

• There were systems in place to ensure that learning from significant events was clearly documented and disseminated throughout the practice to all relevant staff.

• Risks relating to fire, gas and portable electrical appliance safety had been assessed and mitigated.

• All team members were up to date on statutory training to ensure the safety and wellbeing of patients and staff.

• The practice provided evidence that they had improved the governance arrangements for recruitment and had requested suitable references for new personnel.

The practice was also able to demonstrate they were working towards improving their exception reporting figures through increased communication with their patients. They had initiated a text reminder service in November 2016 to call patients in for annual review and commenced a personalised telephone reminder service for some patient groups. These systems were reported to be working well, although the initiatives had occurred too recently to offer any comparable data. They had also reviewed the patient equality and accessibility issues and had undertaken repair work to the automatic entrance doors to make access easier for less able bodied patients. They had access to a telephone based interpretation service and all staff were aware how to access it for their patients. Although a hearing loop was not yet available, the GP partners had agreed it was necessary and the practice manager was looking at availability and pricing.

We have updated our ratings to reflect these changes. This report should be read in conjunction with the full inspection report.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice