Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harbour Medical Practice on 18 January 2017. Overall the practice is rated as requires improvement.

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.
• Staff were aware of current evidence based guidance. Staff did not always have up to date training to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• 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 told us they found it difficult to make an appointment with a GP of their choice which meant they did not always have continuity of care. 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 management. The practice proactively sought feedback from staff and patients.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

• Ensure that all practice specific policies and procedures are up to date, reviewed regularly and adhered to. To include, policies for monitoring prescribing of high risk medicines and systems for reviewing test results and medicines reviews.

• Ensure that all staff have received training required for their roles (including safeguarding and Mental Capacity Act 2005) and central training records are kept up to date.

• Conduct regular checks and carry out a health and safety risk assessment to ensure the premises is safe to use.

The areas where the provider should make improvement are:

• Take steps to improve the results for quality and outcomes framework in areas where they are lower than average. For example, for patients with poor mental health and patients with dementia.

• Continue to improve patients’ satisfaction with access to appointments, getting through to the practice by phone and helpfulness of the receptionists.

• Build on the work undertaken so far to identify carers within the practice in order to increase the number of carers known to the practice and help ensure they receive appropriate support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with seven adult patients and one child on the day of the inspection visit, as well as one patient from another practice who was attending an ultrasound appointment. We spoke with two of the GPs, the estates manager, the practice manager, a practice nurse, health care assistant, medical student, office manager, sonographer and one of the receptionists. We also spoke with an external health care professional.

Patients told us that they felt well informed and involved in making decisions about their care and treatment. They said that all staff were approachable. We found that confidentiality was protected. Patients were happy with the care and treatment they received and valued the local services provided. However, some found that they could not always get an appointment with the same doctor.

We looked at the processes that the practice had in place to ensure the patients were protected from abuse. We found that not all staff had received appropriate training on all safeguarding issues. Staff spoken with understood that any suspicion of abuse needed to be reported.

Staff told us that they had training and development opportunities and that they were well supported by the provider. They felt qualified for their roles and responsibilities.

We found processes in place to review and monitor the quality of the service provided. Patient surveys were conducted with the results analysed. There was learning from the processes and the information was used to improve the service.

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Harbour Medical Practice on 18 January 2017 we found breaches of regulation relating to the safe care and treatment and good governance. The overall rating for the practice was requires improvement and specifically we found the practice to require improvement for the provision of safe and effective services. It was good for providing, caring, responsive and well-led services. Consequently we rated all population groups as requires improvement. The previous inspection reports can be found by selecting the ‘all reports’ link for Harbour Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced desktop inspection carried out on 16 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 18 January 2017. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made the required improvements since our last inspection and was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Overall the practice is rated as good.

Our key findings were as follows:

• There had been improved monitoring of training and staff had access and received the training required to support them in their specific roles.
• Improved risk assessment and action plans were in place.
• Medicine review monitoring had improved to ensure safer prescribing of high risk medicines.
• There had been action taken to improve the management of patients with long term conditions.

The provider had taken action on areas we suggested they should make improvements:

• A new appointment system had been implemented for patients to stagger the availability of appointments. When urgent appointments were not available, GPs called back a patient to undertake an assessment of how urgent their need was to either offer advice or an appointment. The practice informed us the new system had received positive comments. The practice informed us that patients who ‘do not attend’ appointments had fallen from 79 appointments in December 2016 to 55 in June 2017.
• The practice implemented a new carers’ protocol. There was a carers’ champion in place at the practice to help support the needs of carers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice