This practice is rated as requires improvement overall. The practice was previously inspected in April 2016, where the practice was rated as Good overall. In October 2018, the practice was inspected and rated as requires improvement overall, requires improvement for providing safe, effective caring and responsive services, inadequate for providing well-led services. As a result of these findings enforcement action was taken and a warning notice in relation to Regulation 17 was issued and a requirement notice in relation to Regulation 12.

We carried out an announced comprehensive inspection at Hampton Health on 9 May 2019.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 16 October 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 and for all population groups.

We found that:

• Since our last inspection the practice had made improvements and strengthen leadership and management. Some of these actions had been newly implemented, and some needed further improvement and embedding to be able to demonstrate they had been sustained and were effective. In addition, we identified some new areas of concern.
• The practice had improved access to their services but had not undertaken full patients’ surveys to fully evaluate the improvement in patient satisfaction. Comments on NHS choices and patients we spoke with gave positive feedback on the changes made to accessing services.
• The practice was in a position of change and were merging with other practices. The benefits of this change such as a wider skill mix of staff offering more services had not had enough time to be monitored fully and evaluated to demonstrate improvements in the data that is available.
• Patients received effective care and treatment that met their needs. We had seen improvements in patient care for example care plans for patients experiencing poor mental health.
• We saw staff deal with patients with kindness and respect and patients we spoke with told us they were involved in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Access to care and treatment had improved.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We rated the practice as requires improvement for providing safe services because;

• We found risk assessments had been undertaken but some of these needed to further improve such as those relating to fire safety.
• We found the practice had not undertaken a risk assessment to be assured that all emergency medicines were available to keep patient safe where appropriate.
• We found some patient group directions (PGDs) for nurses to administer medicines were out of date and the system in place was not effective to ensure all medicines were dispensed to patients safely.
• Prescription stationary was stored securely but the practice did not have a system to monitor it’s use.
• The practice had improved the reporting and recording of significant events however this had not been fully embedded as not all events were reported formally.

We have rated the practice and all the population groups except for people with long term conditions as good for providing effective services. We have rated the population group of people with long term conditions as requires improvement because;

Published and verified Quality and Outcomes Framework data used in this report showed high levels of exception reporting for people with long term conditions. The practice shared with us their unverified data and exception reporting for the Quality and Outcome Framework for 2018/2019. From this data we saw that in generally the practice had improved their performance and reduced their exception reporting. However, we noted that outcomes for the performance for managing people with diabetes were lower than those that the performance in 2017/2018.

We rated the practice as requires improvement for providing caring services because;

• This report contains GP Patient Survey data published in July 2018 and the practice had not undertaken their own surveys to gain patient feedback to see if the changes they have been making have been effective.

We rated the practice and all the population groups as good for providing responsive services and for providing well-led services.

The areas where the provider must make improvements as they are in breach of regulations are;

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements;

• Continue to improve the identification of carers to enable this group of patients to access the care and support they need.
• Further embed and monitor the effective of reporting and learning from significant events however minor.
• Continue to develop systems and processes to gain patient feedback such as patient participation and surveys. Monitor changes made to evidence they have been effective and result in improved patient satisfaction.
• Review and implement systems and processes to evidence that all staff are competent to undertake their role.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as requires improvement overall. The practice was previously inspected in April 2016, where the practice was rated as Good overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Requires Improvement

Are services responsive? – Requires Improvement

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Hampton Health on 16 October 2018 as part of our inspection programme.

At this inspection we found:

• The practice did not have clear management oversight to ensure systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice did not always evidence that they had shared the learning and improved their processes.

• We found that the practice had not made all improvements to address the concerns identified in our two previous inspection reports. The process for recording and handling complaints was not effective, this had been raised on our most recent inspection visit to the practice.

• There was a lack of oversight to ensure that the systems and processes in place to mitigate risks to patients such as health and safety were reviewed and monitored appropriately.

• The system in place did not ensure all significant events were recorded, that learning was shared and changes made and monitored.

• Quality Outcomes Framework indicators for patients diagnosed with a mental health condition were significantly lower than the CCG and national averages.

• We reviewed a number of care plans for patients diagnosed with a mental health condition and found that were they had been completed, they did not contain adequate information and were not completed to a standard in line with relevant guidance.

• Patient feedback from the GP Patient Survey data 2018 and reviews of the practice on NHS Choices and Google Reviews showed the dissatisfaction of patients. The practice failed to show they had taken actions to improve this.

• The practice was not actively involved in quality improvement activity. The practice did not complete clinical audits to monitor and improve the quality of clinical care provided.

• Childhood immunisation uptake rates were above the target percentage of 90% or above with a range of 95% to 98%.

• Patients who were identified as being a carer were provided with immediate telephone access through the duty GP.

• Patients who had presented to A&E with self harm were proactively followed up by the GPs at the practice.
• The practice was involved in the implementation of evening and weekend appointments through a network of local GP practices.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements:

• Review and improve the system for identifying patients with caring responsibilities.

Professor Steve Field CBE FRCP FFPH FRCGPChief 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 Hampton Health on 30 March 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 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.
• 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.
• 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:

• Ensure that the learning from complaints is shared and disseminated with the appropriate staff within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out this visit to check on the improvements made following concerns we identified when we last inspected the service in July 2013.

We visited the service in July 2014. We found that the required improvements had been made to the service.

There were arrangements in place to ensure that patient's were protected against the risks of unsafe or unsuitable premises and equipment. There were assessments in place to identify risks to patien'ts health and safety. Where areas for improvement were identified there were clear actions in place to address these issues. The liquid Nitrogen cylinder used in cryotherapy (the use of cold temperatures in the treatment of skin lesions) had been replaced with a cryosurgical device.

There were suitable arrangements for appraising staff performance and identifying training and development needs. There was a training plan for staff and this was monitored to ensure that staff undertook appropriate training for their roles and the work they performed. There were arrangements for supervising staff, including clinical supervision for nursing staff.

There were arrangements for monitoring and improving the quality and safety of services provided. We saw from the minutes of staff meetings that learning from accidents, incidents and significant events was promoted through discussion and developing actions to address concerns.

When we visited Hampton Health we found that people were involved in decisions about their care and treatment and were happy with the service. Some people said they had difficulties arranging suitable appointments.

One person said, “Staff have been very good to me here” but another person said they felt the doctors did not always listen to them or take their concerns seriously.

Although the layout of the reception and waiting area did not help to promote privacy, staff took steps to ensure that patient confidentiality was respected. We also saw evidence that staff considered the diverse needs of the population.

We spoke with patients and staff, checked records and observed a staff meeting which demonstrated that care and treatment was planned and delivered in appropriate ways and in line with national guidance.

The premises were not entirely suitable for the service although plans were in place to move to new premises. There had been no assessment of the environmental risks so that actions could be taken to ensure people were protected from the use of unsuitable or unsafe premises.

There were no evidence to demonstrate that a liquid nitrogen cylinder was being used or stored in a safe way. The provider has since written to us confirming there were plans to remove this from use.

Feedback was used to improve the quality of the service but there were insufficient processes in place to assess and monitor incidents, complaints, staff training and appraisal.