Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Fairhill Medical Practice on 31 August 2016. The overall rating for the practice was Good. However the practice was rated as requires improvement for providing effective services due to having higher than expected levels of exception reporting (the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects) under the Quality Outcomes Framework (QOF). The full comprehensive report can be found by selecting the ‘all reports’ link for Fairhill Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focussed inspection carried out on 25 May 2017 to confirm that the practice had carried out their plan to make the required improvements we identified in our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made.

Overall the practice is now rated as Good.

Our key findings were as follows:

• The practice had reviewed the levels of and processes for exception reporting, and had taken steps to improve outcomes for patients.

• Although the most recent published data from 2015/16 showed that the practice exception reporting rate was still higher than local and national averages in some areas, unpublished data for 2016/17 indicated that the exception reporting had decreased in a number of clinical areas.

• Up to date risk assessments for health and safety, infection control and fire safety were in place, and were subject to monitoring and review.

• The practice had increased the regularity of non-clinical staff meetings.

• Information about how to complain was on display at the practice.

The area where the provider should make improvements are:

• Continue to review and monitor recently implemented initiatives to improve exception reporting of patients in the cervical screening programme, in order to improve these measures in the Quality and Outcomes Framework.

At this inspection we found that although the practice was still below local and national averages for exception reporting under the Quality and Outcomes Framework (QOF) for some measures, evidence was seen that changes had been undertaken to reach more of these patients. This included patients with conditions such as coronary heart disease, chronic obstructive pulmonary disease, dementia and rheumatoid arthritis. Consequently, the practice is now rated as good for providing effective services, and remains good overall.

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 on 31 August 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• Risks to patients were generally assessed and managed, however the practice did not have a documented fire risk assessment or health and safety risk assessment in place at either the practice on Kingston Hill or the branch surgery at Fairfield Kingston .
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice employed clinical staff with specialist training and qualifications to better care for their patient population, which had a high proportion of young people at one branch surgery not visited during this inspection.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Data from the Quality and Outcomes Framework (QOF) showed that in 2014/2015 patient outcomes were in line with local and national averages; however their exception reporting rate was higher than expected for some indicators.

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review its levels of and processes for exception reporting and take all necessary steps to improve outcomes for patients.

• Carry out regular risk assessments for health and safety, infection control fire safety in line with practice policy, and monitor and review actions arising.

• Review the regularity of non clinical staff meetings.

• Ensure information about how to complain is on display at the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice