We carried out an announced comprehensive inspection at Hatfield Road Surgery on 19 September 2017. Overall the practice was rated as good. However, we identified breaches of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided well-led services. Consequently the practice was rated as requires improvement for providing well-led services. The full comprehensive report on the September 2017 inspection can be found by selecting the ‘all reports’ link for Hatfield Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 April 2018 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 on 19 September 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

On this focused inspection we found 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 well-led services.

Our key finding was as follows:

• There were effective governance arrangements in place to ensure complaints were managed in accordance with the practice’s policy and procedure and the absence of a defibrillator was appropriately risk assessed.

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

• The practice kept a record of fire drills. We saw that the fire drill completed in January 2018 had been documented. This included a record of how many staff and patients were involved, the time taken by them to evacuate the building and that all employees and visitors were accounted for during a roll call among other things. The record showed that no further action was required as a result of the drill as all staff had correctly followed procedure and the alarm system worked as it should.
• Following our inspection in September 2017 the practice had reviewed and updated its business continuity plan. We saw the plan now contained details of how the practice would respond to any loss of premises, power, telephones and medical records among other things. This included an arrangement for the temporary use of space at another local practice in an emergency situation. We saw the plan contained up-to-date contact details for all staff at the practice along with those of service providers such as utility companies. From our conversations with staff we found that both GP partners and the practice manager kept a copy of the plan off-site should the practice be inaccessible in an emergency situation.
• The practice discussed the below average uptake among its patient population for some nationally run and managed cancer screening programmes. The staff we spoke with demonstrated an understanding of the cultural sensibilities to such programmes displayed by some of its patient population. There was evidence to suggest the practice responded to those sensibilities and encouraged its relevant patients to engage with them and attend for screening. For example, between them the GPs at the practice could offer consultations in languages other than English including Bengali, Hindi and Urdu. Many of the practice’s patients with English as a second language could be informed about and encouraged to attend the cancer screening programmes by the GPs in their first language during consultations. We saw the practice acted on information it received from NHS England about patients who had not responded to their invitations to participate in the bowel cancer screening programme. Between 1 April 2017 and 31 March 2018 the practice wrote to 98 such patients encouraging them to participate. We noted the letters were always sent in English but at the time of our inspection the practice was considering sending translated versions of the letter for the relevant patients.

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 Hatfield Road Surgery on 19 September 2017. Overall the practice is rated as requires good.

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

• Risks to patients were assessed and well managed, with the exception of those relating to the need for a defibrillator and certain emergency medicines.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. However, complaints were managed informally and not in accordance with the practice policy or the recognised guidance and contractual obligations for GPs in England.
• The practice had a basic business continuity plan in place. It did not cover actions to take for major incidents such as power failure or building damage. There were no emergency contact numbers in the plan for staff. A copy of the plan was not kept off site for use if the building was not accessible.
• The practice had an up to date fire risk assessment and carried out regular fire drills. However, they did not keep a record of the fire drills that included information such as who was involved, time taken to evacuate the building and any lessons learnt.
• 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 had been trained 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.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had recently moved to new premises and 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice had identified 64 patients as carers which equated to approximately 2% of the practice list. There was a carers’ champion and the practice had achieved gold level of the Herts Valleys Local Incentive Scheme by completing a survey of their carers to demonstrate satisfaction and an awareness of the carers champion and support available to them.

The areas where the provider must make improvement are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. For example, complete a risk assessment to identify the reasons and mitigating actions, for not having a defibrillator and manage complaints in accordance with the practice policy and the recognised guidance and contractual obligations for GPs in England.

The areas where the provider should make improvement are:

• Keep a record of all fire drills.
• Continue to encourage patients to attend cancer screening programmes.
• Have an effective business continuity plan.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice