Letter from the Chief Inspector of General Practice

We last carried out a comprehensive inspection of Dr Nelson and partners, also known as Harley House Surgery on 19 November 2014 and found there were a number of areas for improvement. At the last inspection the practice was found to be requiring improvement for aspects of the safe and well led domains. This made the practice requiring improvement overall for all the population groups. The report was published on 31 March 2015. This inspection on 3 August 2015 was specifically to follow up on the findings from our last inspection in November 2014.

We found the practice was now meeting the relevant regulations and was now rated as good for safe and well led. Services for all of the population groups were now rated as good overall.

Our key findings were as follows:

• We found patient records and information was now kept securely at all times.
• All staff who were used as chaperones had in place a disclosure and barring service check.
• There were arrangements in place to deal with medical emergencies appropriately and changes had been made with emergency medicines held at the practice, including those held in GP home visit bags.
• We found the practice had completed clinical audits cycles and the results from these had been shared with others in the team to maintain a consistent approach in treating patients.
• Policies and procedures reviewed reflected current guidance and evidenced that these had been recently reviewed.
• Guidance was followed when providing results for anticoagulant testing to patients in nursing homes and residential care homes.

We saw several areas of outstanding practice including:

• The practice provides care and treatment to approximately 100 patients who have a learning disability who reside in a life skills college and working hotel. The practice had received the Fox’s academy community award 2014 for their support and patience in enabling learners to work towards independence. Students had also been invited and attended the patient participation group.
• The nurse practitioner had provided additional training for local services. For example, they had provided training for staff to administer ear and eye drops to patients who reside in the life skills college. They had also provided additional tissue viability training for the nurses at one of the local nursing homes.
• The practice had held an open day within the last year to promote awareness of what the practice could offer to patients in regards to health promotion, such as smoking cessation and signposting to local support services. It was also an opportunity to encourage patients to sign up for online appointment booking. Patients could also have their blood pressure and cholesterol checked by the nursing team. We were told 120 patients and other members of the community attended this open day.

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 Harley House Surgery on the 19 November 2014. During the inspection we gathered information from a variety of sources. For example, we spoke with patients, members of the patient forum, interviewed staff of all levels and also checked the right systems and processes were in place.

Overall the practice is rated as requires improvement. This was because we found the practice required improvement in providing safe and well led services to patients. We found they had good practice for providing responsive, effective and caring services. The concerns found in safe and well led effected everyone using the practice which meant even though we found the practice was providing some good practice for all the population groups this made them requiring improvement overall.

Our key findings were as follows:

• The practice was accessible to patients who needed to be seen the same day. The practice had a triage and ‘sit and wait’ system used each day to enable any patient to be seen and patients were prioritised by appropriate staff.
• There was a high satisfaction rate from the patients in the practice; patients felt they were treated with respect and kindness from all staff the majority of the time.

We saw several areas of outstanding practice including:

• The practice provides care and treatment to approximately 100 patients who reside in a life skills college and working hotel for people with a learning disability. The practice had received an award from the Fox’s academy community award 2014 for their support and patience in enabling learners to work towards independence. Students had also been invited and attended the patient participation group.
• The nurse practitioner had provided additional training for the local services. For example, they had provided training for staff to administer ear and eye drops for the life skills college. They had also provided additional tissue viability training for the nurses at one of the local nursing homes.
• The practice had held an open day in the last year to promote awareness of what the practice could offer in regards to health promotion, such as smoking cessation and local support services. It was also an opportunity to encourage patients to sign up for online appointments. Patients could also get their blood pressure and cholesterol checked by the nursing team. We were told 120 patients and other members of the community attended this open day.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure patient records are secure at all times to ensure patient confidentiality.
• Ensure there are suitable emergency medicines and appropriate medicines in home visit bags to deal with a medical emergency and maintain risk assessments for these medicines as outlined in current researched guidance.

• Ensure clinical audits follow a clear purpose including completing cycles to ensure procedures were embedded and shared learning within relevant members of the team to maintain a consistent approach in treating patients.

• Ensure policies and procedures reflect current local or national guidelines, inform staff of their responsibilities in current practice procedures and are reviewed at appropriate timescales.

In addition the provider should:

• Undertake risk assessments for employee roles which do not require a criminal background check and who may be required to act as a chaperone.

• Ensure GPs follow current guidance when providing results of anticoagulant results to its patients in nursing and residential homes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice