Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harvey Group Practice on 30 November 2016. The overall rating for the practice was good. However, we identified breaches of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided safe services. Consequently the practice was rated as requires improvement for providing safe services. The full comprehensive report from the 30 November 2016 inspection can be found by selecting the ‘all reports’ link for Harvey Group Practice on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to;

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014

- Safe care and treatment.

The areas identified as requiring improvement during our inspection in November 2016 were as follows:

• Ensure an appropriate system is in place for the safe use and management of medicines including medical consumables and controlled drugs prescriptions.
• Ensure that sufficient fire safety systems and processes are in place and adhered to.

In addition, we told the provider they should:

• Take steps to ensure that hot water temperatures at the practice are kept within the required levels.
• Ensure that all staff employed are supported by receiving appropriate supervision and appraisal and are completing the essential training relevant to their roles, including safeguarding, infection prevention and control and basic life support training.
• Ensure that all GPs have sufficient knowledge of the Deprivation of Liberty Safeguards (DoLS) and that a DoLS register is in place.
• Continue to identify and support carers in its patient population.
• Continue to take steps to ensure that in future National GP Patient Surveys the practice’s areas of below local and national average performance are monitored and improved, including access to appointments.

We carried out an announced focused inspection on 15 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches of regulation that we identified in our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key finding on this focused inspection was that the practice had made improvements since our previous inspection and were now meeting the regulation that had previously been breached.

The practice is now rated as good for providing safe services.

On this inspection we found:

• A sufficient process was in place and adhered to for recording the collection of controlled drugs prescriptions.
• Staff completed appropriate checks on the stock and expiry dates of all medicines and medical consumables.
• Sufficient fire safety systems and processes were in place and adhered to.

Additionally where we previously told the practice they should make improvements our key findings were as follows:

• All staff had completed adult and child safeguarding, infection prevention and control and basic life support training within the required timescales.
• Some cold and hot water temperatures recorded at both surgeries were outside the required levels. Following investigation of the causes of this, the practice was considering its options as to how best to proceed to resolve the issue. In the meantime, the practice had measures in place to assist in reducing any risks to staff and patients.
• A programme was in place to ensure all staff received an appraisal on an annual basis and this was on schedule. We found that all non-clinical and nursing staff employed for more than a year, including those previously overdue their annual appraisals, had been offered or received a fully documented appraisal by December 2016.

• We saw that following our November 2016 inspection the practice took immediate action and introduced a Deprivation of Liberty Safeguards (DoLS) policy and process. (The Deprivation of Liberty Safeguards is a process used to lawfully deprive a person in a care home or hospital of their liberty in certain circumstances). A DoLS register was in place and this included the practice’s computer system alerting staff if a patient was subject to a DoLS process. The GPs we spoke with demonstrated a comprehensive understanding of the Deprivation of Liberty Safeguards including changes made to the legal requirements in April 2017.

• The practice had been proactive in increasing the amount of carers identified in its patient population and those offered a health review. We saw that a process was in place for all identified carers to receive a written invitation for an annual health review and the flu vaccination. We saw that part of the full staff meeting on 24 May 2017 was dedicated to discussing carers and the staff we spoke with told us they were encouraged to be proactive in identifying carers and informing them of the services available to them. The practice also held a carers’ week in June 2017 to encourage the identification of carers and promote the services offered to them. As of 9 August 2017 the practice had identified 368 patients on the practice list as carers. This was approximately 2.8% of the practice’s patient list and double the number identified in November 2016. Of those, 346 (94%) had been invited for a health review in the past nine months. This was a vast improvement on the 0% formally invited for a health review in the 12 months up to our inspection in November 2016.
• The practice demonstrated they had taken action to improve their below average satisfaction scores from the National GP Patient Survey published in July 2016. For example, the practice audited its appointments provision in January 2017 and following analysis of the results implemented various changes designed to make the appointments system more accessible to patients. This was done along with other changes not related to the audit. The results from the National GP Patient Survey published in July 2017 showed improvement in the areas previously of concern. For example, 46% of patients said they always or almost always saw or spoke with the GP they preferred compared to the Clinical Commissioning Group (CCG) average of 62% and the national average of 56%. Although still below local and national averages, this represented an improvement of 9% from the 37% satisfaction score achieved in July 2016.

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 Harvey Group Practice on 30 November 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.
• The practice had many clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. However some systems, processes and practices relating to medicines management were insufficient.
• There were some procedures in place for monitoring and managing risks to patient and staff safety. However, at the time of our inspection the systems and processes in place relating to fire safety were insufficient.

• 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.
• The patients we spoke with or who left comments for us were very positive about the standard of care they received and about staff behaviours. They said staff were thorough, considerate, understanding and caring. They told us that their privacy and dignity was respected 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.
• Most patients were positive about access to the practice and appointments. Some patients said getting an appointment in advance could be difficult and there could be a considerable wait to see a GP of their choice when making a pre-bookable appointment. However, they said that access to urgent and same day appointments was good.
• 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 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 must make improvements are:

• Ensure an appropriate system is in place for the safe use and management of medicines including medical consumables and controlled drugs prescriptions.
• Ensure that sufficient fire safety systems and processes are in place and adhered to.

The areas where the provider should make improvements are:

• Take steps to ensure that hot water temperatures at the practice are kept within the required levels.
• Ensure that all staff employed are supported by receiving appropriate supervision and appraisal and are completing the essential training relevant to their roles, including safeguarding, infection prevention and control and basic life support training.
• Ensure that all GPs have sufficient knowledge of the Deprivation of Liberty Safeguards (DoLS) and that a DoLS register is in place.
• Continue to identify and support carers in its patient population.
• Continue to take steps to ensure that in future National GP Patient Surveys the practice’s areas of below local and national average performance are monitored and improved, including access to appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice