This practice is rated as Good overall. (Previous rating April 2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Hamd Medical Practice on 20 November 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear 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. Although performance was below local and national averages in some areas such as childhood immunisation and cervical cancer screening, the practice was able to demonstrate how they had worked to improve these areas. This was supported by unverified data provided during our inspection which confirmed that uptake in these areas were meeting the required standards and targets.
• The practice proactively identified patients with commonly undiagnosed conditions and patients at risk of developing long term conditions such as diabetes. We saw how through systematic identification and monitoring, pre-diabetic patients were identified and referred to prevention programmes to help in preventing the development of diabetes. Furthermore, the practice was able to provide examples of how this approach led to a reduction in patients HbA1c (blood sugar) levels.
• Staff involved and treated patients with compassion, kindness, dignity and respect. Patient feedback was mostly positive with regards to care and treatment overall.
• The practices GP patient survey results were below local and national averages for questions relating to access to care and treatment, in addition to some questions regarding kindness, respect and compassion. The practice provided evidence of an action plan which outlined areas that the practice was working on to improve, however the evidence provided failed to demonstrate if satisfaction rates had improved.
• The practice provided staff with ongoing support. Staff training and learning was tested in a creative and engaging way during practice learning sessions. Staff stated they felt respected, supported and valued. They were proud to work in the practice. We saw that the practice reflected on things that went well and positive performance was celebrated through initiatives such as ‘employee of the month’.

The areas where the provider should make improvements are:

• Continue with efforts to improve uptake rates with regards to childhood immunisation and cervical screening.
• Focus on improving satisfaction rates in response to the below average results of the national GP patient survey.
• Continue to identify and capture carers to ensure they are offered support where needed.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hamd Medical Practice on 22 April 2016. The practice had previously been inspected in May 2015 and was rated as requires improvement overall. This included an inadequate rating for safe and requires improvement for effective and responsive. We returned to re-inspect to consider whether sufficient improvement had been made. We found the practice had made significant improvements and now has an overall rating of good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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 was able to demonstrate improvements made to patient outcomes in most areas.
• 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.
• Patients usually found it easy to make an appointment when they needed one 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 business continuity plan to ensure it contains details for contacting staff in the event of a major incident.
• Review processes to try and encourage greater uptake of childhood immunisations among under five year olds.
• Review and improve the support available for patients who have difficulty hearing.

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 Hamd Medical Practice on 6 May 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing effective and responsive services and inadequate for providing safe services. As a result, we found the practice requires improvement in providing services for people with long term conditions, families, children and young people, working age people, older people, people in vulnerable groups and people experiencing poor mental health. It was good for providing a caring and well led service.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, information regarding significant events was not recorded in detail, for example not all recorded outcomes and there was limited evidence of learning from these events.
• Data showed patient outcomes were average for the locality. Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
• Not all staff had received training appropriate to their roles.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice did not hold regular governance meetings and issues were discussed at ad hoc meetings.
• 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.
• There was an open culture within the practice and staff were actively encouraged to raise concerns and suggestions for improvement.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

The areas where the provider must make improvements are:

• Implement effective systems in the management of risks to patients and others against inappropriate or unsafe care. This must include systems to ensure effective significant event management, robust systems for the management and handling of complaints, that medication reviews are undertaken in a timely manner, robust recruitment checks for staff, and checks of emergency equipment are undertaken to ensure they are safe and ready to use.
• Ensure completed audit cycles are available that demonstrate improvements made to patients care and treatment.

In addition the provider should:

• Ensure there are effective arrangements in place to review and monitor patients with dementia to ensure they receive the care and support that they need.
• Ensure that appropriate infection control measures are in place with regards to furniture in the practice.
• Review the cold chain policy to include information to guide staff of the action to take in the event of a cold chain failure.
• Systems should be put in place to ensure that patients with end of life care needs are clearly identifiable.
• Consider how they ensure patient records remain relevant and up to date, for example for those patients with a child protection plan in place and systems to alert staff of patients who may require additional support.

Evidence in relation to the well-led domain indicates that the practice has the capacity to make improvements and would be able to put plans in place promptly to make improvements required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice