Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection April 2015 -Good)

The key questions are rated as:

Are services safe? – GOOD

Are services effective? –GOOD

Are services caring? – GOOD

Are services responsive? – GOOD

Are services well-led? – Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) – Good

We rated the population groups as GOOD overall.

We carried out an announced comprehensive inspection at Dr Pervez Sadiq on 14 March 2018. This was a part of our inspection programe. Overall the practice is rated as good.

At this inspection we found:

• The practice had 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.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements:

• Ensure good governance of systems and processes is established and operated to ensure compliance with the requirements of the regulations.

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 Hillside House Surgery on 25 February 2015. Overall the practice is rated as good.

The practice provided safe, effective, responsive care that was well led and addressed the needs of the population it served. The service was caring and compassionate. It was also good for providing services for all the population groups.

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

• Systems were in place to ensure incidents and significant events were identified, investigated and reported. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Lessons learnt were disseminated to staff. Infection risks and medicines were managed safely. However, improvements were needed to ensure staff were safely recruited and that required information in respect of staff was held.

• People’s needs were assessed and care was planned and delivered in line with current legislation and guidance. Staff had received training appropriate to their roles. Patients experienced outcomes that were in line with or above the national average. The practice used innovative and proactive methods to improve patient outcomes. For example care plans were in place for vulnerable and older patients to reduce unplanned admissions. Recall and review systems for patients with long term conditions were effective.

• Patients spoke highly of the practice. They said they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

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

• The practice provided good care to its population that was responsive to their health and socio economic needs. Patients were listened to and feedback was acted upon. Information about services and how to complain was available and easy to understand. Complaints were managed appropriately and lesson learnt from them. 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.

• The practice monitored, evaluated and improved services. There was a clear leadership structure, staff enjoyed working for the practice and felt well supported and valued. The practice proactively sought feedback from staff and patients, which it acted on.

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

.The provider should:

• Ensure its recruitment policy, procedures and arrangements are in line with Schedule 3 of the Health and Social Care Act 2008 to ensure necessary employment checks are in place for all staff and the required information in respect of workers is held.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Pervez Sadiq also known as Hillside House Surgery on 16 January 2019.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 14 March 2018.

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.

We have rated this practice as requires improvement overall.

We rated the practice as good for providing safe services because:

• The practice had systems and processes to keep patients safe in relation to infection prevention and control, however, not all areas were covered.
• Safeguarding systems were robust and the practice made child protection referrals and participated in multiagency child protection meetings as required.
• Receptionists had been given guidance on identifying deteriorating or acutely unwell patients and were aware of the actions to be taken in respect of those patients. This area could be improved if training included information on how to identify and deal with possible sepsis.
• The practice had appropriate systems in place for the safe management of medicines.
• The practice learnt and made changes when things went wrong, however, systems were not always revised and updated to make sure these changes were sustained or monitored.
• Investigations completed by clinical staff used best practice guidance and the finding were shared with all clinical staff.

We rated the practice as good for providing effective services because:

• The outcomes of care and treatment was monitored. The management of urgent test results was robust and the practice was proactive in ensuring patients received the urgent care and treatment as quickly as possible.
• The practice could show that staff had the skills, knowledge and experience to carry out their roles.
• The practice could show that it always obtained consent to care and treatment.
• Performance data was in line with local and national averages.
• The practice however, were not aware and could not explain the reasons where they had higher than local and national exception reporting rates for some performance data. (Exception reporting allows practices to exclude some eligible patients from indicators and practices should be able to identify the reasons for these exclusions.)

We rated the practice as

good

for providing caring services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

We rated the practice as requires improvement for providing responsive services because:

• Complaints were not handled in accordance with the Health and social care act 2008 regulations. At this inspection we found systems and processes for managing complaints were in place however, these were not used effectively. For example, patients were not informed of how to make complaints because there was no information, such as a poster or leaflets about raising concerns in the practice waiting area. This information had to be requested. Complaints we reviewed had not been managed in line with the regulations because records about how the complaints were investigated were incomplete and there was no evidence that the complainant had been responded to appropriately. There was, however a means to record verbal complaints.
• Patients received individualised care and the practice was responsive to different needs in relation to accessing the service. There were no unacceptable barriers to accessing the services.
• Patients said they had timely access to services, the appointment system was easy to use and the information technology available supported their access to services.

This area affected all population groups so we rated all population groups as requires improvement.

We rated the practice as

requires improvement

for providing well-led services because:

• The practice had made some improvements since our inspection on 14 March 2018, it had appropriately addressed the Requirement Notice in relation to monitoring and reviewing policies and procedures; improving the processes to ensure effective infection prevention and control; ensuring staff training in emergency response was effective and adherence to staff recruitment and induction policies. However, monitoring and reviewing processes were unplanned, inconsistent and did not cover all aspects of the service.
• Leaders could show they had the capacity and skills to deliver high quality, sustainable care, however a written business plan had not been developed.
• The practice had a clear vision which was supported by a credible strategy.
• The practice culture effectively supported high quality sustainable care.
• The practice acted on appropriate and accurate information.
• We saw evidence of systems and processes for learning, continuous improvement and innovation, however learning from serious incidence was not always embedded.
• The practice still needed to improve some processes for managing risks, issues and performance and ensure that these were operating as intended.
• The practice had not developed a comprehensive review plan for the service.

The areas where the provider must make improvements are:

• Ensure that any complaint received is investigated and proportionate action is taken in response to any failure identified by the complaint or investigation and ensure there is an effective system for identifying, receiving, recording, handling, and responding to complaints by persons in relation to caring on of the regulated activity.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review the development of risk registers to include all vulnerable groups of patients.
• Introduce a cleaning schedule which includes areas and equipment that should be periodically deep cleaned.
• Provide administration staff with training in how to recognise and deal with potential sepsis.
• Review how the systems in place to monitor and support improvements at the practice are used.
• Record all investigations in detail so the information available meets best practice guidance.
• Consider how to check whether consent to treatment is correctly obtained at the practice.

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