This practice is rated as Good overall. (Previous inspection October 2017 – Good overall, with requires improvement rating for providing Safe services)

The key questions are rated as:

Are services safe? – Good

We carried out an announced focused inspection at Hill Top Medical Centre, on 1 August 2018. This inspection was in response to previous focused inspection at the practice in October 2017, where breaches of the Health and Social Care Act 2008 were identified. You can read the report from our last focused inspection on 11 October 2017; by selecting the 'all reports' link for Hill Top Medical Centre on our website at www.cqc.org.uk.

At this inspection we found:

• The practice had introduced an effective system to routinely review the effectiveness and appropriateness of the care it provided to ensure patients on high risk medicines were monitored on a regular basis.
• At previous inspections, results from the national patient survey showed accessing the practice by telephone was below local and national averages. The practice had implemented increased access through longer opening hours including weekends and encouraging patients to use the online services available.
• Since the last inspection the number of patients using the online facilities had increased from 26% to 40%.
• All staff had received refresher training on where the emergency equipment was situated in the case of unforeseen medical emergencies.
• The practice continued to demonstrate improvements in their achievements of the quality and outcomes framework (QOF) system and effectively monitored patients to ensure they were receiving the appropriate monitoring and care.

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 Hill Top Medical Centre on 28 November 2016. The overall rating for the practice was good. However, we rated the practice requires improvement for providing effective care (one of the five questions we ask practice). The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Hill Top Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 11 October 2017 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 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

• During our previous inspection in November 2016 we found that the systems to monitor patients prescribed high risk medicines were not always effective. At this inspection we saw the practice had introduced regular searches to ensure monitoring of high risk medicines such as Disease-modifying anti-rheumatic drugs (DMARDs). However, the practice had not considered all high risk medicines for regular review.

• The practice had reviewed its processes for prescription stationery and ensured that they were logged to minimise the risk of fraud.

• The practice had carried out an Infection Prevention and Control (IPC) audit and action was taken to improve the identified areas.

• The practice had reviewed its recruitment process and evidence we looked at demonstrated that appropriate processes were in place and being followed.

• All staff had been made aware of the location of emergency equipment and staff members we spoke with were able to demonstrate this.

• The practice had purchased two hearing loops and door bells had been installed to enable those patients using a wheel chair to call for assistance.

• During our previous inspection we saw results from the national GP patient survey published in July 2016 showed that patients’ satisfaction with how they could access care by telephone was below local and national averages. During this inspection survey results published in July 2017 did not reflect any improvements. However, since 2 September 2017 the practice had changed its opening hours and was now open from 8am to 8pm Monday to Friday and weekend access was also available. The practice had increased the number of patients registered to use online services. Data we looked at showed 38% of patients on the practice list were registered and 26% were actively using the service.

• Examples of complaints we looked at from the previous 12 months demonstrated that they were responded to appropriately with all responses being documented.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way through effective systems to mitigate risks to patients prescribed high risk medicines.

In addition the provider should:

• Ensure all staff are aware of the location of the spare emergency medicine kit.
• Continue to monitor QOF achievement to ensure improvement is maintained.

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 of Hill Top Medical Centre on 28 November 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Learning was shared with staff and reported to external agencies when required.
• Required recruitment checks had been made before a member of staff was employed to work at the practice. However, the physical and mental health of newly appointed staff had not been considered.
• The systems in place to mitigate risks to patients who took high risk medicines were not always effective.
• An overarching training matrix and policy was in place to monitor that all staff were up to date with their training needs and received regular appraisals.
• Patients said they found urgent appointments were available the same day but the appointment system was a cause for complaint for a number of patients when trying to make a routine appointment to see a GP.
• Feedback from patients about their care was consistently positive and was reflected in the national patient survey results; last published in July 2016.
• The practice had reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a written set of objectives and values supported by a written business plan that reflected this strategy and ensured the future direction of the practice was monitored and evaluated.
• The practice had visible clinical and managerial leadership. Most governance and audit arrangements were effective.

The areas where the provider must make improvement are:

• Ensure that systems to mitigate risks to patients prescribed high risk medicines are fully effective.
• Implement effective systems to manage patients with long-term conditions, specifically asthma and diabetes.

The areas where the provider should make improvement are:

• Ensure that infection prevention control audits take into account the most recent nationally recognised guidelines.
• Implement processes to demonstrate that the physical and mental health of newly appointed staff have been considered to ensure they are suitable to carry out the requirements of the role.
• Review safeguarding policies to ensure they include updated categories and definitions for types of abuse. Ensure all staff are familiar with the policies and are aware of the safeguarding leads.
• Implement an effective prescription tracking system to minimise the risk of fraud.
• Ensure all staff are aware of where emergency medicicines and equipment are kept.
• Complete modifications to ensure that the premises are suitable for patients with reduced mobility and any hearing impairment.
• Explore ways to improve telephone access for patients.
• Record verbal interaction and outcomes when resolving complaints over the telephone.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice