Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gravel Hill Surgery on 18 January 2016. A breach of a legal requirement was found and a requirement notice was served. The practice sent us an action plan to say what they would do to meet the legal requirement in relation to:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment.

The overall rating for the practice was good and the full comprehensive report for the January 2016 inspection can be found by selecting the ‘all reports’ link for Gravel Hill Surgery on our website at www.cqc.org.uk.

We undertook an announced focused inspection on 6 April 2017. We did not visit the practice but reviewed the information sent to us by the provider to confirm that the practice had carried out their plan to address the breach in one regulation that we identified during our January 2016 inspection. This report only covers our findings in relation to those requirements and additional improvements made since our last inspection.

Our key findings were as follows:

• The practice had a register of 31 patients with learning disabilities. In 2016 all of these patients had been invited to attend an annual health check. Sixteen had received a health check, 11 declined, three had not responded and one had not attended their appointment.

• The provider had risk assessed the policy for exception reporting patients without clinical input. Exception reporting is 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.

• The provider had implemented a system for monitoring the use of prescription pads that minimised the risk of fraud by logging the sequential numbers of pads used.

Overall the practice is rated as good and good in the population group for people whose circumstances may make them vulnerable. This recognises the improvements made to the service provided for patients in this population group.

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 Gravel Hill Surgery on 18 January 2016. Overall the practice is rated as Good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the Care Quality Commission (CQC) at that time.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with 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.
• Patients told us they could get an appointment when they needed one. Urgent appointments were 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 the management. The practice proactively sought feedback from staff, patients and third party organisations, which it acted on.

• The practice provided a high number of home visits to its patients. We saw that the GPs had completed 172 home visits in November 2015 and 186 in December 2015.

We saw one area where the practice must improve. The practice must:

• Have a robust system to complete annual health checks on patients with a learning disability.

We saw one area where the practice should improve. The practice should:

• Risk assess the policy for excepting patients from receiving treatment without clinical input.

Have a robust system to account for prescription pads and forms within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We reviewed the information available to us about Gravel Hill Surgery on 8 June 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.