Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hereward Group Practice on 12 October 2016. Overall the practice is rated as good.

The purpose of this inspection was to ensure that sufficient improvement had been made following the practice being placed in to special measures as a result of the findings at our inspection on 4 February 2016 when we found the practice to be inadequate overall.

At this most recent inspection we found that significant improvements had been made and specifically, the ratings for providing a safe and well led service had improved from being inadequate to good. Effective was good. The rating for providing a caring and responsive service had improved from requiring improvement to good.

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

• The practice had a governance framework in place with systems and processes in place to support the delivery of their strategy.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• The practice had put an effective system in place to safeguard adults and children from abuse.
• Risks to patients were now well assessed and extremely well managed.
• The leadership and systems and processes for the dispensary had been reviewed.
• The system in place for palliative care monitoring and review was in the process of being reviewed and the practice were beginning to put new processes in place.
• The practice now had a quality improvement programme in place which included a rolling programme for clinical audit cycles.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Monitor the systems in place for the recording of consent, follow up on children who do not attend for childhood immunisation and staff who still need to complete mandatory training.

• Monitor the recently introduced process for tracking prescriptions to ensure that it meets national guidance.

• Follow up their assessment of the post office collection points to ensure that they meet the agreed standards

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

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 Hereward Group Practice on 4 February 2016. Overall the practice is rated as Inadequate.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However learning from incidents and complaints was not always disseminated to all staff.

• Risks to patients were not assessed and well managed.
• The practice did not have a robust system in place to monitor the training of the GPs and staff within the practice. For example, not all clinical staff had received appropriate training in safeguarding to ensure they were up to date with current procedures.
• Dispensing errors were not reliably recorded and there was limited evidence for any being written up as Significant Events.
• Dispensary Service Quality Scheme (DSQS) documentation had been completed by the Practice Manager but evidence was found that some of the entries were incorrect. For example, Standard Operating Procedures were not updated on yearly basis.
• Data showed patient outcomes were high compared to the locality and nationally. Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
• There was not a robust system in place to ensure that the summarising of paper records for new patients who had registered with the practice was completed in a timely manner.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There were omissions in the records of vaccine refrigerator temperature checks.

• Urgent appointments were available on the day they were requested.
• The practice had a number of policies and procedures to govern activity. However some were overdue a review.

The areas where the provider must make improvements are:

• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision. For example,Health and Safety, fire, legionella.

• Ensure there is adequate leadership in the dispensary and systems and processes in the dispensary are robust.
• Take action to address identified concerns with infection prevention and control practice.
• Ensure learning from significant events and complaints is shared with staff.
• Embed a process to ensure staff training is monitored and all staff are up to date with mandatory training.
• Ensure recruitment arrangements include all necessary employment checks for all staff and are in line with Section 3 of the Health and Social Care Act 2008.
• Embed a system where fridge temperatures in all treatment rooms are checked and reset in line with practice policy

• Have a system in place for the summarising of patient notes. Clear the backlog of paper records for new patients.

• Ensure the mechanisms in place to seek feedback from staff and patients are robust and feedback is acted upon to ensure the practice improves services and the quality of care given to patients.

• Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.

In addition the provider should:

• Review significant events to ensure themes and trends are identified.
• Ensure all staff have mental capacity awareness training.
• Ensure all staff have a yearly appraisal

I am placing this practice in special measures. Where a practice is rated as inadequate for one of the five key questions or one of the six population groups and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.

Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or varying the terms of their registration within six months if they do not improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as good overall (at the previous inspection undertaken in 12 October 2016, the practice received a good overall rating).

The key questions are rated as:

Are services safe? – Good

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 – Good

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

We carried out an announced comprehensive inspection at Hereward Group Practice on 28 February 2018 and 27 March 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• There was a structured approach to risk within the practice and this was well managed by the leadership team.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• GPs and practice staff worked effectively as a cohesive team and provided personalised and responsive care to their patients.
• There was a walk in surgery on Monday mornings and extended hours every Saturday morning to alloy for flexibility in the way appointments were available.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• In response to some GPs leaving employment with the practice, there was the introduction of an ‘Acute Illness team’, which increased the number of appointments and allowed for the reception team to book the most appropriate clinician for the patients need.
• There was a clear leadership structure and staff told us they felt well supported by the partners and practice manager. We observed the positive impact this had in establishing a well-integrated practice team.

We saw the following areas of outstanding practice:

• The practice had implemented a quality management system to ensure each part of the practice was achieving the required standards.

However there were areas of practice where the provider should make improvements:

• Review the levels of patient satisfaction, and continue to improve in relation to access to the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice