We carried out an announced comprehensive inspection at Highcroft Surgery on 16 March 2016. Overall the rating for the practice was requires improvement and the practice was asked to provide us with an action plan to address the areas for improvements. A second announced comprehensive inspection was carried out on 3 November 2016 in order to review progress made by the practice. The practice was given an overall rating of good, with a rating of requires improvement for providing responsive services.

We carried out a third comprehensive inspection on 2 August 2017, which was announced at short notice to assess the areas previously highlighted as requiring improvement and respond to concerns reported by stakeholders about access to the service. During the inspection on August 2017, the practice was given an overall rating of good, with a rating of requires improvement for providing responsive services. The previous inspection reports can be found by selecting the ‘all reports’ link for Highcroft Surgery on our website at www.cqc.org.uk.

This inspection was an announced follow up inspection carried out on 8 August 2018. This was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified at the previous inspection. This report covers our findings in relation to those requirements.

Our key findings were as follows:

• The practice had taken action to improve patient satisfaction in relation to accessibility and monitored this through surveys and audits
• Feedback from patients and data reviewed showed improvements were being achieved to the appointment system, waiting times and getting through to the practice by telephone.
• However, access to appointments was an ongoing issue and further plans were in place to increase availability by recruitment and collaborative working with local practices as part of a GP federation.
• We identified that the practice took appropriate action to information received from the Medicines and Healthcare Regulatory Agency (MHRA). However, the practices process for documenting this was not appropriate to demonstrate this. We told the provider that they should improve the process.

The areas where the provider should make improvements are:

• Ensure the recording of alerts received from the Medicines and Healthcare Regulatory Agency (MHRA) clearly reflects the actions taken and the outcomes achieved.

• Continue acting to improve patient satisfaction in relation to access to appointments.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Highcroft Surgery on 16 March 2016. Overall the rating for the practice was rated as requires improvement and the practice was asked to provide us with an action plan to address the areas of concern that were identified during our inspection.

A second announced comprehensive inspection was carried out on 3 November 2016 in order to assess improvements and the outcomes from their action plan. The action plan had been fully completed, and the practice was now meeting all legal requirements. The practice was given an overall rating of good, with requires improvement for providing responsive services.

We carried out a third comprehensive inspection on 2 August 2017 which was announced at short notice (two days before the inspection) to assess the areas previously highlighted as requiring improvement and respond to concerns reported by stakeholders about access to the service. The overall rating for this practice is good.

Our key findings were as follows:

• Telephone access had improved since the telephone system was upgraded. However, access to GP appointments remained a problem for patients. The practice continually reviewed their service and subsequently introduced further changes to improve patient experience in terms of access, and some of these changes were still being embedded. We did receive some positive feedback from patients that we spoke with, that indicated that the situation was improving.
• Feedback from patients about their care, and their interactions with all practice staff, was mixed. Whilst patients said they were treated with dignity and respect by clinicians, a number of them expressed difficulties in getting routine appointments to discuss test results.
• The latest national GP survey (July 2017) showed patient satisfaction in respect of GP consultation experiences was broadly in line with local and national averages. However, experiences relating to getting appointments remained significantly lower than local and national averages.
• The practice provided primary medical services to patients across three local care and nursing homes. Feedback from the care homes indicated the relationship with the practice continued to improve and meetings between the practice and the homes were ongoing to ensure the service met their needs.

• There were systems in place to support the reporting and recording of significant events. Lessons were shared to ensure action was taken to improve safety in the practice.

• 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 practice used clinical audits to review patient care and we noted several examples of how outcomes had been used to improve services as a result.

• The practice provided modern purpose-built facilities and was well-equipped to treat patients and meet their needs. Its co-location with a large number of other community health providers facilitated good patient access to a range of other services.
• The practice had a proactive patient participation group (PPG) who worked closely with the practice and helped to influence developments.

The area where the provider must make some improvements is:

• The provider should continue to work towards improving patient experience by assessing and monitoring access to appointments.

The area where the provider should make improvements is:

• Consider strengthening the process for the management of alerts received from the Medicines and Healthcare Regulatory Agency (MHRA)

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 Highcroft Surgery on 16 March 2016. Overall the rating for the practice was rated as requires improvement and the practice was asked to provide us with an action plan to address the areas of concern that were identified during our inspection.

We carried out a second announced comprehensive inspection at Highcroft Surgery on 3 November 2016 in order to assess improvements and the outcomes from their action plan. The overall rating for this practice is good.

Our key findings were as follows:

• Following our previous inspection in March 2016, the practice submitted an action plan to address the legal requirements that the provider was not meeting. At our second inspection we observed that the action plan had been fully completed, and the practice was now meeting all legal requirements.
• Access to GP appointments remained a problem for patients. However, we noted the number of actions that the practice had instigated to improve patient experience in terms of access, and some of these changes were still being embedded. We did receive some positive feedback from patients that we spoke with, and from our comment cards, that indicated that the situation was improving.
• The practice provided primary medical services to patients across a number of local care and nursing homes. Concerns were raised about the quality of this service at our inspection in March 2016. We spoke with managers at three homes in November 2016, who reported that the service had become more responsive and that communication channels had been improved. Whilst there were still some issues to be resolved, the general view was that improvements had been achieved.
• The practice worked with the wider multi-disciplinary team to plan and deliver care to keep some vulnerable patients safe. Feedback from community based staff was mixed in respect of the accessibility and responsiveness of some the practice team with regards to communication.
• Since our inspection in March 2016, the practice had appointed an advanced nurse practitioner who acted as the lead for patients with a learning disability. This led to a review of the service to ensure the practice was providing comprehensive annual health checks. We saw evidence that 56% of patients with a learning disability had received a review within the last three months, and plans were in place to achieve a review of all these patients within 12 months.
• Following concerns regarding pre-employment checks at our previous inspection in March 2016, the practice had assessed all existing and new staff to check if a Disclosure and Barring Service (DBS) check was required. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable). We observed that these had been completed at our inspection in November 2016, including those staff who had previously been appointed using DBS checks carried out by other organisations.
• The systems in place to support the reporting and recording of significant events had been strengthened since our previous inspection. Lessons were shared to ensure action was taken to improve safety in the practice.
• 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.
• Feedback from patients about their care, and their interactions with all practice staff, was mostly positive. Patients said they were treated with dignity and respect by clinicians, and that they were usually involved in their care and decisions about their treatment. The latest national GP survey (July 2016) demonstrated an increase in satisfaction by approximately 10% in respect of GP consultation experiences.
• The practice used clinical audits to review patient care and we observed example of how outcomes had been used to improve services as a result.
• The practice provided modern purpose-built facilities and was well-equipped to treat patients and meet their needs. Its co-location with a large number of other community health providers facilitated good patient access to a range of other services.
• The practice had a proactive patient participation group (PPG) who worked closely with the practice and helped to influence developments.

The areas where the provider should make improvement are:

• Continue to work towards improving the availability of non-urgent appointments.
• Strengthen the process for the management of alerts received from the Medicines and Healthcare Regulatory Agency (MHRA)
• Review the documentation of staff inductions and appraisals.

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 Highcroft Medical Centre on 16 March 2016. The overall rating for this practice is requires improvement

We rated the practice as requires improvement for providing safe, caring, effective, responsive, and well-led services. The concerns which led to these ratings apply across all the population groups we inspected.

Our key findings were as follows:

• The practice had experienced a recent turbulent period in which a number of key staff had left the practice. The partners had ensured continuity of service throughout this period and new recruitment had started to impact positively upon service delivery. The newly appointed practice manager was co-ordinating actions to address key priorities including recruitment and access to appointments.
• Access to GP appointments was a significant problem for patients. Feedback from a variety of sources indicated that patients were unhappy with the appointment process. The practice was aware of the problems and had developed actions, including a review of reception hours, to ensure more staff were available to deal with incoming patient requests.
• The practice provided primary medical services to patients across a number of local care and nursing homes. Staff at two of these homes expressed a number of concerns with the service which they did not feel was responsive to effectively manage their patients’ needs.
• The practice worked with the wider multi-disciplinary team to plan and deliver effective care to keep some vulnerable patients safe. However the practice had only carried out annual health checks for 32% of their learning disability patients in the last 12 months.

• There was a system in place to support the reporting and recording of significant events, although processes were not sufficiently robust. Lessons were generally shared to ensure action was taken to improve safety in the practice, although this was not consistently recorded.

• 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.
• Feedback from patients about their care, and their interactions with all practice staff, was generally positive. Most patients said they were treated with dignity and respect by clinicians, and that they were usually involved in their care and decisions about their treatment. However, there were a number of comments made with regards to a poor experience received from dealing with reception both by telephone and face-to-face.

• The practice used clinical audits to review patient care and we observed example of how outcomes had been used to improve services as a result.

• The practice had excellent facilities and was well-equipped to treat patients and meet their needs. Its co-location with a large number of other community health providers facilitated good patient access to a range of other services.
• The practice had a proactive patient participation group (PPG) who championed the voice of patients and influenced practice developments. The PPG were also highly supportive of the practice and were helping them to introduce positive changes for patients.

The areas where the provider must make improvement are:

• Ensure recruitment arrangements include all necessary pre- employment checks for all staff.

• Ensure that risks to patients are identified, assessed and mitigated. For example, by ensuring either a Disclosure and Barring Service check is completed or a risk assessment is available to identify why this is not necessary; and to review the care provided to patients in local care and residential units to ensure this is responsive to patients’ needs.

• Ensure that robust and safe arrangements are implemented to support the safe management of medicines within the practice and reviewing the stock of medicines kept on site and their secure storage.

• Ensure patients with a learning disability receive an annual review to enable their health and well-being needs are met.

The areas where the provider should make improvement are:

• Continue to work towards improving the availability of non-urgent appointments.

• Review the need for a more robust approach to the recording of significant events so mechanisms are in place to ensure effective learning is applied across the practice team.

• Review the need for a more formal structure for staff meetings and the need to provide documentary evidence of discussions held and agreed actions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice