We carried out an announced comprehensive inspection at Highgrove Surgery on 03 December 2018 as part of our inspection programme.

At the last inspection in November 2016, we rated the practice as good overall.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall because:

• Most medicines were prescribed, administered or supplied to patients in line with current national guidance. However, the provider did not have an effective system in place for monitoring patients on high risk medicines.
• The practice had a health and safety policy but this was not operating as intended. The partners were responsible for the health and safety in the practice. The practice had not risk assessed the need for carrying out their own safety checks in the surgery environment, independently from checks performed by Barking Hospital’s NHS property services.
• The practice had a training matrix to record the dates staff had completed training and the renewal dates for annual training. However, this had not been maintained and some entries on the staff training matrix were not consistent with the dates on training certificates. There was no record of safety training for the salaried GP who worked at the practice.
• At our inspection we found Childhood immunisation uptake rates were below the World Health Organisation (WHO) target percentage of 90% or above in three of the four target areas.
• There was a system to manage infection prevention and control, but this did not mitigate all of the risks.
• The practice did not have a system to monitor patient feedback. At this inspection the practice told us they had not reviewed the 2018 results from the GP National Patient Survey, and had not independently undertaken any alternative patient satisfaction monitoring.
• The practice did not have safe systems to monitor and track blank prescriptions.

The overall rating for this practice was requires improvement due to concerns in providing safe, effective and well-led services. The population groups were rated as requires improvement for people with long term conditions and families children and young people because there were concerns about timely review of patients on high risk medicines and figures showed the practice performance was below average/national targets, with no substantive plans to improve.

The areas where the provider

must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Improve uptake of childhood immunisations and cervical screening.
• Maintain the record of entries in staff training matrix against certifcates of training.
• Review the availability of practice information in easy read format.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice