We carried out an announced follow up inspection at Hockley Medical Practice on 28 March 2019 to follow up on concerns that we identified during our inspection of the practice in March 2018.

During our inspection in March 2018 we rated the practice as good overall with a requires improvement rating for providing safe services and requires improvement for the population group, people whose circumstances may make them vulnerable.

We rated the practice and all other population groups as good for providing effective, caring, responsive and well-led services.

During this inspection in March 2019 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.

During this inspection in March 2019, we found that t

he practice had responded appropriately to the concerns we identified during our inspection in March 2018 and we have rated this practice as good for providing safe services and good for the population group, people whose circumstances may make them vulnerable.

• The practice had reviewed their medicines management systems to ensure patients were monitored and reviewed in line with guidelines.
• We saw the practice had effective systems for monitoring patients on high risk medicines and responding to correspondence from secondary care.
• The practice had reviewed their storage and security of prescription stationery and the practice now had an effective monitoring and audit system in place.
• The practice had improved their monitoring systems for staff training and staff vaccination information.
• The practice had acted to ensure all patients with learning disabilities had been invited for annual reviews. Staff told us it remained a significant challenge for the practice to improve uptake of appointments with this population group however they were trying to be be proactive in their approach.
• We reviewed two audits the practice had completed since our last inspection. Both audits showed improved outcomes for patients. The first audit showed improved care of post-natal patients with gestational diabetes. The second audit showed an improvement in the management of patients with newly diagnosed hypertension.
• We saw the practice was actively trying to identify carers and the number of carers on their patient list had increased slightly from 54 to 60 since our last inspection.
• We saw from published data for 2017 to 2018 that the practice had achieved an increased uptake for childhood immunisations however, uptake levels were slightly below the national target.
• From published data for 2017 to 2018 we saw that the uptake for cervical and bowel cancer screening had reduced since our last inspection. Staff we spoke with told us about the action they were taking to try and improve uptake and provided unverified data to show uptake for cervical screening between April 2018 and the time of inspection had increased when compared with data from 2017/2018.
• The practice contacted patients who failed to attend their screening appointments and was engaging with Cancer Research UK on how to increase uptake for bowel cancer screening.

Whilst we found no breaches of regulations, the provider should:

• Continue to improve the identification of carers to enable this group of patients to access the care and support they need.
• Continue to explore different methods to improve monitoring of patients with learning disabilities.
• Continue to improve uptake for childhood immunisations and cancer screening.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Hockley Medical Practice on 13 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice had some systems to manage risk, but we found these needed strengthening in relation to the security of blank prescriptions.
• Staff understood their responsibilities to raise concerns, incidents and near misses. When incidents did happen, the practice learned from them and improved their processes.
• We found some clinical audits had been completed; however, audits did not demonstrate quality improvements.
• The practice ensured that care and treatment was delivered according to evidence based guidelines. They worked with a range of health and care professionals in the delivery of patient care.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Results from the GP national patient survey showed high levels of satisfaction in relation to consultations with GPs and nurses.
• There was a clear leadership structure and staff felt supported by management. There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Continue to review how the practice could proactively identify carers in order to offer them support where appropriate.
• Review correspondence to ensure all changes are acted on promptly.
• Review the current programme of clinical audits to demonstrate what quality improvements have been made.
• Continue to encourage patients to attend immunisation and national screening programmes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice