Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hartwood Healthcare on 3 December 2015. Following our comprehensive inspection overall the practice was rated as good with requires improvement for the safe domain. Following the inspection we issued requirement notices. The notices were issued due to a breach of Regulation 12 of The Health and Social Care Act (Regulated Activity) Regulations 2014, Safe care and treatment and for a breach of Regulation 19 of The Health and Social Care Act (Regulated Activity) Regulations 2014, Fit and Proper persons employed.

The issues were:

• Regulation 12: The provider must ensure the Patient Group Directions adopted by the practice to allow nurses to administer medicines in line with legislation are signed by the clinical governance lead for the nursing staff.

• Regulation 19: The provider must ensure that personnel employed to carry on the regulated activity did not have the appropriate checks through the Disclosure and Barring Service and the practice did not hold the required specified information in respect of persons employed by the practice as listed in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

A copy of the report detailing our findings can be found at www.cqc.org.uk.

We carried out an announced focused inspection at Hartwood Healthcare on 4 October 2016 to follow up the requirement notices which were issued on 3 December 2015 and to assess if the practice had implemented the changes needed to ensure patients who used the service were safe.

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

• We saw evidence that the provider had ensured there were safe systems in place for Patient Group Directions. These were adopted by the practice to allow nurses to administer medicines in line with legislation had been signed by the clinical governance lead for the nursing staff.

• We saw evidence that the provider had ensured that an appropriate system was in place for personnel employed to carry on the regulated activity. Staff now had the appropriate checks through the Disclosure and Barring Service and the practice now held the required specified information in respect of persons employed by the practice as listed in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following this inspection the practice was rated overall as good and good across all domains.

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 Hartwood Healthcare on 3 December 2015. Overall the practice is rated as good. Improvements were required in the safe domain, and there were areas in the effective domain which were outstanding.

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 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, 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.

We saw areas of outstanding practice:

• There had been 11 clinical audits completed in the last year, all of these were relating to medicines, the associated treatment plans and monitoring of patients. A particular focus was on the prescribing of psychotropic medicines for patients with learning difficulties. This raised awareness of necessity for a higher quality of reviews of prescribing for patients with learning difficulties. More detailed information was now included in the patient records to inform of the decision for prescribing specific medicines.
• Smoking cessation advice and support was provided by five of the nursing staff at the practice; they had been identified as having the second highest numbers of smoking cessation in the Clinical Commissioning Group area for 2014-2015. They had achieved 51% ‘quit rate’ after 12 weeks of patients starting on the programme.

The areas where the provider must make improvement are:

• The provider must ensure the Patient Group Directions adopted by the practice to allow nurses to administer medicines in line with legislation are signed by the clinical governance lead for the nursing staff.
• The appropriate checks through DBS had not been undertaken by the provider as they had used information from a previous employer. The practice had a recruitment checklist but these had not been utilised fully to ensure that the required information had been retained.

The areas where the provider should make improvement are:

• The provider should define the lines of accountability within the practice for the shared services and ensure all areas of the practice are included in the infection control audit such as the consultation rooms.
• The practice could not provide information in regard to an overarching written business continuity plan in place for major incidents such as power failure or building damage. Staff provided detail and supporting evidence of what steps they would take should an event arise including contact details of external bodies, power suppliers and emergency services.
• All staff had had an appraisal within the last 12 months. Through discussion with the registered manager,the lead GP, it was identified that clinical responsibility for the shared resource of the treatment room nurse team was not clear.
• The practice should develop a systematic approach to reviewing trends or themes of complaints or concerns expressed to the practice. There should be a recorded system to monitor trends or themes of the significant events.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We were welcomed by patients and staff when we visited. The practice manager had put together a programme of events for our visit so that we had a variety of patients and staff to speak with. This included us attending nurse consultations. We spoke with patients in the waiting room and over the phone.

Patients were complimentary about the practice. Comments included, "I have a very nice doctor with a sense of humour”, “I find the service is consistently good”, “The reception staff, manager and nurses are friendly, it’s not easy for them but they always try to help us” and “They always do the best they can”

We were supported throughout our visit by a dedicated management team and various other clinical and non-clinical staff. All staff involved in the inspection clearly supported the practice and their commitment to deliver high quality clinical and medical services in a manner that would significantly improve the patient experience.

Patients experienced effective, appropriate care, treatment and support that met their needs and promoted their wellbeing. Patients felt safe and were protected from abuse or the risk of abuse because of the policies and procedures that the practice followed. There were effective recruitment and selection processes in place. There was effective decision making and management of risks to patient’s health, welfare and safety. The quality of the services was monitored to help ensure best practice so that care and treatment was effective.