We carried out an announced comprehensive inspection at Hatton Medical Practice on 28 September 2017. The overall rating for the practice was requires improvement. The practice was rated as requires improvement for providing safe and caring services as the practice had not taken action on areas related to safety within the practice environment and patients rated the practice lower than others in relation to a number of aspects of caring. The full comprehensive report on the September 2017 inspection can be found by selecting the ‘all reports’ link for Hatton Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 16 October 2018 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 28 September 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as good in all key questions.

The practice is now rated good overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• Since our last inspection the practice had implemented safety systems to improve prescription security, mandatory training updates for staff, documenting significant events discussed at practice meetings, and monitoring cleaning schedules.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Since our last inspection the practice had improved the number of carers identified and patient feedback relating to caring questions, although some questions relating to consultations remained below average in the 2018 national GP patient survey.
• Feedback from patients we spoke with and CQC comments cards stated staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a focus on continuous learning and improvement at all levels of the organisation. The practice was proactive in monitoring performance to ensure improvements implemented were sustained.

The areas where the provider should make improvements are:

• Take action to ensure all staff are aware of the location of emergency equipment.
• Take interim action to identify and minimise the infection control risks associated with the flooring and walls in consulting rooms.
• Continue to review and improve uptake for childhood immunisations, and cervical and bowel cancer screening.
• Continue to review and improve patient satisfaction with consultations.
• Monitor coding for patients on the atrial fibrillation and rheumatoid arthritis disease registers.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hatton Medical Practice on 2 June 2015. The overall rating for the practice was good. However, the practice was rated as requires improvement for providing safe services. The full comprehensive report on the June 2015 inspection can be found by selecting the ‘all reports’ link for Hatton Medical Practice on our website at www.cqc.org.uk.

This inspection was undertaken to check the provider had taken the action we said they must and should take and was an announced comprehensive inspection on 28 September 2017. Overall the practice is now rated as requires improvement.

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, although only brief details were recorded and agreed actions were not documented in the minutes of full practice meetings when discussing lessons learned.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented sufficiently in all respects to ensure patients were kept safe. Several shortcomings identified at our previous inspection had been addressed but some action had not been implemented in full and some additional shortcomings were found.
• 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, although mandatory update training for the majority of staff was overdue at the time of the inspection but completed since.

• Data from the national GP patient survey showed patients rated the practice lower than others in relation to a number of aspects of caring.

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Not all patients we spoke with said they found it easy to make an appointment with a named GP but the practice was taking action to improve access to appointments.
• The practice had the facilities and equipment 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.

However, there were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure care and treatment is provided in a safe way to patients. In particular: to do all that is reasonably practicable to mitigate the risks to the health and safety of patients receiving care and treatment associated with: the proper and safe management of medicines (relating to prescription security); the safe use of premises and equipment (regarding Carbon Monoxide monitoring); and in ensuring sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to deliver a safe service,(specifically relating to mandatory training updates).

In addition the provider should:

• Record in more detail in the minutes of full practice meetings the discussion of lessons learned and agreed actions from significant events.

• Arrange for to be signed and dated for each task.

• Review the system for the identification of carers to ensure all carers have been identified and provided with support.

• Implement an action plan to address the relatively low scores for the caring questions on the national GP survey.

• Keep the practice’s action plan to improve patient access to appointments under close monitoring and review.

• Strengthen governance arrangements regarding performance monitoring to ensure ongoing shortcomings in providing safe services and access to appointments are addressed.

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 Hatton Medical Practice on 2 June 2015.

Overall the practice is rated as Good.

Specifically, we found the practice to be good for providing, effective, caring, responsive and well-led services. It was also good for providing services to the six population groups we looked at: older people; people with long-term conditions; families, children and young people; working age people (including those recently retired and students); people whose circumstances may make them vulnerable; and people experiencing poor mental health (including people with dementia).

We found the practice requires Improvement for providing safe services.

Our key findings were as follows:

• Staff were clear about reporting incidents, near misses and concerns and there was evidence of communication of lessons learned with staff.

• The practice worked in collaboration with other health and social care professionals to support patients’ needs and provided a multidisciplinary approach to their care and treatment.

• The practice promoted good health and prevention and provided patients with suitable advice and guidance.

• The practice had several ways of identifying patients who needed additional support, and was pro-active in offering this.

• The practice learned from patient experiences, concerns and complaints to improve the quality of care.

• The practice had a clear ethos that put patients first and was committed to providing the best possible service to them.

• There was an open culture and staff felt supported in their roles.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure patients are fully protected against the risks associated with the recruitment of staff, in particular in ensuring all appropriate pre-employment reference checks are carried out and recorded prior to a staff member taking up post.

In addition the provider should:

• Ensure a record is kept of the serial numbers of prescription forms to conform with national guidance.

• Ensure that when daily checks of medicine storage fridge temperatures are carried out the signature of the member of staff completing the checks is recorded.

• Ensure gaps in staff training in infection control and fire safety are addressed and evidence of all training completed is documented in staff records; and arrange for outstanding annual appraisals to be conducted for staff due one.

• Review the practice’s consent protocol to ensure mental capacity is appropriately taken into account.

• Take steps to raise clinical staff awareness and understanding of deprivation of liberty safeguards (DoLs).

• Make a written record of GP partner meetings to document action agreed to drive improvement, and enable follow up and review of progress to be tracked at subsequent meetings.

• Consider inviting regular locum GPs to the partner meetings to engage them more fully in clinical assessment, monitoring and review.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice