We carried out an announced comprehensive inspection at GP at Hand on 30 and 31 January 2019 as part of our inspection programme.

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 good overall, with a rating of requires improvement for providing effective services.

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

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen.
• When incidents did happen, the practice evidenced that they had learned from them and improved their processes.

We rated the practice as requires improvement for providing effective care because:

• Performance for childhood immunisations was significantly below the World Health Organisation (WHO) minimum target of 90%.
• Uptake of the practice’s cervical screening programme was significantly below the target 80% coverage and bowel and breast cancer screening rates were below local and national averages.

• Quality improvement activities demonstrating improvements in the quality of care patients received was limited.

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

• Patients reported that they were treated with kindness, respect and compassion.
• The practice respected patients’ privacy and dignity.

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

• Patients found the appointment system for booking online consultations easy to use and reported that they were able to access care when they needed it. Although, some patients reported delays with face to face appointments and getting through to the support centre by phone.
• Patients told us they did not always receive their referrals and test results in a timely way. However, there was clear evidence that the practice had taken action to improve workflow processes in relation to these.
• The practice had appropriate facilities and was equipped to treat patients and meet their needs.
• Complaints were handled in a timely way.

We rated the practice as good for providing well-led services because:

• The practice had strengthened leadership and governance with the implementation of a subcontracted senior management team. There was strong and visible clinical and managerial leadership and governance arrangements.
• There was evidence of a strong focus on continuous learning and improvement at all levels of the organisation.

Whilst we found no breaches in regulations, the provider should:

• Strengthen links with health visitors and other agencies to ensure vulnerable children are helped, supported and protected.
• Review two week wait referral processes to ensure patients are being followed up.
• Improve the quality of clinical assessment record keeping for face to face consultations.
• Implement a system to ensure individual patients who may have particularly worrying symptoms are followed up to ensure further tests or investigations are done.
• Develop quality improvement activities to improve outcomes in the quality of care patients receive.
• Review staffing numbers to meet the increasing demand for travel vaccinations, long-term condition management, out-of-hospital services, cervical screening and childhood immunisations.
• Identify and support more patients who have carer responsibilities.
• Review the whistleblowing policy to ensure it includes sufficient information on reporting concerns to external organisations.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.