We carried out an announced comprehensive inspection at Haresfield Medical Practice on 31 January 2019 as part of our inspection programme.

At the last inspection in June 2015 we rated the practice as good overall with outstanding for responsive.

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 and outstanding for Well-led and the population group of long term conditions because:

• The practice offered a range of comprehensive services to support and manage long term conditions. In in addition to these reviews the practice monitored patients with neurological and osteoporosis conditions.
• The practice had upskilled staff in diabetes, leg ulcers and respiratory conditions and offered specialist clinics which included multiple sclerosis reviews and bronchiectasis.
• The practice coordinated a wellbeing clinic for the review of long terms conditions for patients and their carers. This took place annually during the patient’s birth month. A bespoke appointment was set up dependant on their health needs. Multiple conditions were reviewed in one appointment and were coordinated with clinicians in the practice. All patients who were identified as a carer were invited to a wellbeing clinic review.

We have rated this practice as outstanding for Well-led services because:

• The practice used information technology to support them to manage capacity and performance. The practice had developed a protocol and  system to help them manage GP availability and appointments in a planned way. Monthly audits were carried out around clinical capacity and the demand for appointments which reduced the need for patients to be seen in the sit and wait overflow appointments. The National Survey results for 2018 could evidence that the practice was higher than local and national averages in the type of appointment patients were offered.

• The practice completed an access survey data during a twelve month period and this data was used to support the appointment access system, as well as determine the growth in patient population and clinical capacity. This supported the practice in the recruitment of more GPs to give extra access to patients due to the increase in demand.

The practice had been rated as outstanding for responsive at the last inspection in 2015. It was rated as good on this inspection because:

• The practice were previously involved in a number of initiatives such as The X-Pert Diabetes Programme and providing cover for Worcester intermediate care unit, however a number of these services had stopped and were now being carried out externally.

We also rated the practice as good for providing, safe, effective, caring and responsive services because:

• The practice demonstrated a strong leadership team with clear roles, responsibilities and lead areas and values. The culture of the practice and the way it was led and managed drove the delivery and improvement of high-quality, person-centred care.
• The practice continued to use information technology to support them in the sustainability and succession planning of the practice, for example the use of a dashboard and the matching of GP availability and appointments.
• There were clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
• The practice worked proactively with other organisations to ensure patients had access to a range of services to support their health and wellbeing.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.
• The practice worked proactively with the Patient Participation Group (PPG) to undertake a number of surveys and responded to patients’ need.
• The practice had a strong culture of learning and development. It regularly hosted medical students from a number of universities and was part of the research network. It regularly encouraged staff to undertake further learning and training to increase the skill mix within the practice and embedded this time in their working week.

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

• Develop a process to ensure that controlled drugs are removed for destruction in a timely way.

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

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 Haresfield House Surgery on 19 June 2015. Overall the practice is rated as good.

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. The practice recorded information about safety and reviewed, monitored and took any action that was necessary.
• The practice assessed risks to patients and managed these well.
• The GPs and practice nurses assessed patients’ needs and planned and delivered care following best practice guidance.
• Staff received training appropriate to their roles and the practice identified and planned any further training needs.
• Patients were positive about the practice and described staff as kind, compassionate and professional. Most patients had good experiences of contacting the practice and obtaining appointments.
• The practice provided information about how to complain which was easy to understand and aimed to use information from complaints positively to help them improve.
• The practice was well equipped to treat patients and meet their needs.
• There was an open and supportive approach to management and staff felt supported by their colleagues and by the partners
• The practice encouraged and valued feedback from patients and had an active patient participation group (PPG) which was positive about their developing relationship with the practice team.

We saw several areas of outstanding practice including:

• The practice designated one GP each morning to carry out all the home visits. They began the visits at the start of the day. This enabled patients to receive treatment at home promptly, including any medicines they needed and so decreased the potential for them to need a hospital admission. Requests for hospital admissions which were necessary could be arranged early in the day. Data showed that the practice had fewer unplanned admissions and lower accident and emergency attendance than the national average.
• The practice manager had contributed to the development of a local proactive care team for older people. This involved contributing to work on the design, staffing model, recruitment and implementation of the service.
• One of the practice nurses specialised in diabetes and ran the X-pert Diabetes Programme for patients at the practice. They invited all newly diagnosed patients to attend but the sessions were also open to longstanding patients. This provided information, advice and support for patients and in particular those with a new diagnosis and those needing to establish effective control of their diabetes. The practice aimed to review patients twice a year and the nurse maintained direct telephone contact so patients could contact them easily. The practice held a weekly diabetes clinic with 15 minute appointments and saw approximately 50 patients each month. Newly diagnosed patients had a 45 minute initial appointments. Performance for diabetes related indicators was better than the national average for nine out of 12 indicators we reviewed.
• The practice had hosted an eight week course run by Worcestershire Association of Carers for 40 patients who were carers. This involved providing a room and refreshments as well as identifying patients, funding the cost of sending invitations and co-ordinating the confirmation arrangements.
• One of the practice nurses specialised in leg ulcer care and staffed a local leg ulcer clinic called the Leg Club. The practice funded the nurse’s time for this for one afternoon every one to three weeks although initially this was more frequent. This service was for patients of all the practices in the area. The service provided continuity of care and operated on a ‘drop-in’ basis which provided flexibility for patients in a sociable environment and enabled the nurse to develop her practice and share learning with the practice team.

However there were areas of practice where the provider should make improvements.

• Maintain records of prescription pads in line with guidance from NHS Protect.
• Include minor surgery in their programme of clinical audits.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice