Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of High Glades Medical Practice on 23 February 2016. Breaches of legal requirements were found during that inspection within the well led domain. The practice was rated as good overall, requires improvement in the well-led domain and good in the safe, effective, caring and responsive domains. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements. We undertook a focused inspection on 06 December 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and was rated as good overall and good under the well-led domain. This report only covers our findings in relation to those requirements.

During the previous inspection on 23 February 2016 we found that the areas where the practice must make improvements were:

• To ensure that significant events are investigated and discussed thoroughly, actions taken and lessons learnt and disseminated and to ensure that the accuracy of recording of significant events and complaints is more robust.

This report should be read in conjunction with the last report from 23 February 2016. The report from our last comprehensive inspection can be read by selecting the 'all reports' link on our website at www.cqc.org.uk.

During this inspection we found that:

• Significant events were seen to have been investigated and discussed thoroughly, actions were taken and lessons learnt. We saw that learning points were disseminated to staff and that the recording of significant events and complaints was accurate.

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 High Glades Medical Centre on 23 February 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. Staff were aware of their responsibilities to safety and reported significant events.

• However, when there were unintended or unexpected safety incidents, we saw no evidence that reviews and investigations were thorough enough and lessons learned were not communicated widely enough to support improvement. We also saw some errors in accuracy in the recording of some significant events and also in the detail of recording some complaints.

• 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.
• Some patients said that they found it difficult to get through on the telephone to make an appointment first thing in the morning.
• Appointments were available to book on the 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.

The areas where the provider must make improvements are:

• To ensure that significant events are investigated and discussed thoroughly, actions taken and lessons learnt and disseminated and to ensure that the accuracy of recording of significant events and complaints is more robust.

The areas where the provider should make improvements are:

• To investigate why the percentage of patients with hypertension in whom the last blood pressure reading measured in the preceding 12 months is 150/90mmHg or less is lower than the national and local average and action ways to rectify this.

• To survey, and act upon patient feedback with regard to access to services. This should include telephone access to appointments, considering ways to increase access to the patients’ clinician of choice and whether there is a need for any extended hours access for patients that can’t attend during normal surgery hours.

• To make more health promotion advice and information on services available in the waiting room.

• To ensure that all policies are marked with the practice name, signed and dated.

• To consider obtaining written consent when carrying out joint injections.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at High Glades Medical Practice on 22 and 23 January 2019 under Section 60 of the Health and Social Care Act 2008, as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• There was an effective system for reporting and recording significant events.
• The practice’s systems, processes and practices helped to keep people safe.
• Risks to patients, staff and visitors were assessed, monitored and managed in an effective manner.
• Staff had the information they needed to deliver safe care and treatment to patients.
• The arrangements for managing medicines in the practice helped keep patients safe.
• The practice learned and made improvements when things went wrong.
• Performance for diabetes, asthma, COPD, hypertension and mental health related indicators for 2017 / 2018 was significantly below local and national averages. The practice demonstrated innovation in the way they were addressing performance issues. However, action was ongoing.
• Published results showed the childhood immunisation uptake rates for the vaccines given were higher than the target percentage of 90% or above in all four indicators.
• Staff had the skills, knowledge and experience to carry out their roles.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.
• Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was in line with local and national averages.
• There were clear responsibilities, roles and systems of accountability to support good governance and management locally and at provider management team level.
• The practice had a vision to deliver high quality care and promote good outcomes for patients. However, none of the staff we spoke with were aware of the vision.
• There were processes and systems to support good governance and management locally and at provider management team level.
• The practice was proactive at involving patients, the public, staff and external partners to support high-quality sustainable services.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Revise the security of staff only areas of the practice to restrict access by unauthorised persons.
• Continue to ensure all patient group directions are kept up to date.
• Continue to implement and monitor the action plan in response to the monitoring of the temperature of refrigerators used to store medicines and consider introducing inventories of medicines stored at the practice as well as keep records of any audit checks.
• Continue to work with the local Clinical Commissioning Group to reduce the prescribing of hypnotics.
• Continue to implement and monitor the action plan to further enhance systems to identify and follow up children living in disadvantaged circumstances and who were at risk.

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

Please refer to the detailed report and the evidence tables for further information.