Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Highfield Surgery in Hazlemere, Buckinghamshire on 18 July 2016. Overall the practice is rated as requires improvement.

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

• Over the previous two years the practice had seen a significant amount of staff change including key members of staff retiring. There is now a new management team and revised governance arrangements.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Feedback from patients about access to appointments was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

• The practice had good modern facilities and was well equipped to treat patients and meet their needs.

• Training arrangements were inconsistent and there was no system to identify when staff had training and when it would need to be refreshed. This also led to a lack of a programme of staff appraisals, with no evidence of performance monitoring and identification of personal or professional development.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.

• High standards were promoted and owned by all practice staff with evidence of team working across all roles.

• We observed the practice proactively sought feedback from staff and patients, which it acted on.

There were areas of practice where the provider needs to make improvements. Importantly, the provider must:

• Establish and operate an effective system to assess, manage and mitigate the risks identified relating to legionella and the storage of liquid nitrogen.

• Ensure staff receive appropriate support, training, professional development and appraisal according to their roles. Including for staff providing clinical care and treatment to ensure it’s in line with national guidance and guidelines.

In addition the provider should:

• Review and improve the systems in place to effectively monitor patients with a history of strokes and similar conditions.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

In July 2016 during a comprehensive inspection of Highfield Surgery in Hazlemere, Buckinghamshire, we found concerns related to systems and processes which managed the safe and effective delivery of services. Following the inspection the provider sent us an action plan detailing how they would improve the areas of concern. The previous inspection in July 2016 had found two breaches of the regulations relating to the safe and effective delivery of services.

Using information provided by the practice we carried out a desktop review of Highfield Surgery on 2 November 2016 to ensure these changes had been implemented and that the service was meeting regulations.

The ratings for the practice have been updated to reflect our findings following the improvements made since our last inspection in July 2016; the practice was now meeting the regulations that had previously been breached.

Specifically the practice was:

• Operating safe systems in relation to health and safety. The practice had established and was now operating an effective system to assess, manage and mitigate the risks identified relating to legionella and the storage of liquid nitrogen.

• Training arrangements were consistent; there was a system to identify when staff had training and when it would need to be refreshed. Appropriate appraisal arrangements were now in place, appraisals had been completed and there was evidence of performance monitoring and identification of personal and professional development.

Highfield Surgery had taken full heed of the findings of the inspection undertaken in July 2016 and is now rated good for the provision of safe, effective, caring, responsive and well led services. All six population groups have also been re-rated following these improvements and are also rated as good.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice