Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harford Health Centre on 1 March 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 1 March 2016 inspection can be found by selecting the ‘all reports’ link for Harford Health Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 11 May 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 1 March 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Overall the practice is now rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and 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.
• 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 practice had acted upon the findings of our previous inspection and engaged in a quality improvement programme to review processes and systems specifically around access and develop internal efficiencies. The practice had reported a positive impact on patient satisfaction from feedback through internal surveys, the patient participation group and the Friends and Family Test.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

In addition the provider should:

• Continue to monitor access to appointments and contacting the surgery by telephone to ensure that improvement measures put in place continue to impact positively on patient satisfaction.

• Continue to monitor patient uptake of the cervical screening programme.

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 Harford Health Centre on 1 March 2016. 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 an effective system in place for reporting and recording significant events.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not in all instances implemented well enough to ensure patients were kept safe, specifically in relation to recruitment checks, staff appraisals and mandatory training.
• Data from the National GP Patient Survey showed patient outcomes were significantly lower than local and national averages specifically in relation to appointment access and getting through to the practice on the telephone.
• Although some audits had been carried out, there was no evidence of an ongoing quality improvement programme to ensure outcomes for patients were maintained and improved.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure that had named members of staff in lead roles. However, some governance arrangements needed development specifically in relation to recruitment and mandatory training.
• The practice proactively sought feedback from patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had a number of policies and procedures to govern activity, but some were overdue a review.

The areas where the provider must make improvement are:

• Ensure recruitment arrangements include all necessary employment checks for all staff.

The areas where the provider should make improvement are:

• Ensure there is an effective system for recording to whom prescription pads are issued.
• Develop a system to ensure mandatory training is up-to-date.
• Review the Business Continuity Plan.
• Develop an ongoing quality improvement programme including clinical audit and re-audit to ensure outcomes for patients are maintained and improved.
• Carry out staff appraisals annually and provide structured opportunities for staff to review their performance with their manager.
• Develop a carers' register to ensure information, advice and support is made available to them.
• Improve the availability of non-urgent appointments and review the telephone system to ensure patients can access the surgery in a timely manner.
• Review and update practice policies and procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with a GP partner, a nurse practitioner partner, a phlebotomist, a receptionist and the interim practice manager. We also spoke with ten people using the service and the chair of the practice's patient participation group.

The patients we spoke with said they were happy with the service. One patient said, "the doctors are good. I ask so many questions and it's fine." Another patient said, "I am quite happy with the service. It's quite all right." Patients told us the staff were friendly and respected their privacy. The practice had recently moved into improved premises which patients liked. The environment was clean. There were appropriate arrangements in place to handle emergencies.

Staff received support for professional development. Staff told us they were well supported by their managers and the GP partners. We were told that the practice manager and doctors were approachable and always happy to discuss any issues.

The practice had a range of quality monitoring systems in place. The practice regularly asked patients for their views about the service and effectively involved the patient participation group. The practice team conducted audits and used performance data, incidents, comments and complaints to improve the quality and safety of care.