Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 3 March 2015 Good)

The key questions are rated as:

Are services safe? – requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

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 Pound Hill Medical Group on 28 November 2017 as part of our inspection programme.

At this inspection we found:

• Patients told us they were treated with respect and had confidence in the GPs and nurses they saw. They were involved in planning their care and treatment
• 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.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff were able to develop their skills and felt supported in their work.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice won a HealthWatch England’s “It Starts With You” (from 150 entrants nationally) award jointly with Autism Support Crawley, a local charity for this work and the practice manager was nominated for an Autism Hero award in August 2017.

We saw one area of outstanding practice:

• The practice made significant adjustments when patients found it hard to access services. For example, the practice responded to concerns from families who found it difficult to access the practice due to their child’s specific needs. As a result the practice developed appointment protocols and working arrangements to improve the experiences for patients who were anxious about going to the practice, waiting to be seen in practice and needed help understanding the outcomes of appointments.
• The practice developed pictorial information booklets for adults and children and reviewed with support from Crawley Autism Support (a charity who support individuals who are on the autism spectrum, their families and carers). This approach had been adopted by a number of local practices.

The areas where the provider must make improvements as they are in breach of regulations are:

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

The areas where the provider should make improvements are:

• Review the collation of responses to MHRA alerts to keep a central record that demonstrates actions and outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Pound Hill Medical Group on the 3rd March 2015

The practice has an overall rating of good.

Pound Hill surgery provides primary medical services to people living in the Pound Hill and Copthorne regions of Crawley. At the time of our inspection there were approximately 15,300 patients registered at the practice with a team of seven GP partners. The practice was also supported by two salaried GPS nurses, healthcare assistants and a team of reception and administrative staff. Pound Hill surgery is a training practice and provides training and support to medical students.

The inspection team spoke with staff and patients and reviewed policies and procedures. The practice understood the needs of the local population and engaged effectively with other services. There was a culture of openness and transparency within the practice and staff told us they felt supported. The practice was committed to providing high quality patient care and patients told us they felt the practice was caring and responsive to their needs.

Our key findings were as follows:

• GPs had their own patient lists and where possible encouraged continuity of care by patients seeing their named GP.
• Patient feedback about the practice and the care and treatment they received was very positive.
• The involvement of patients in the development of the practice was positive and inclusive.
• There was evidence the practice was listening to its patients and responding to any concerns or suggestions in a timely and effective manner.
• Infection control audits and cleaning schedules were in place and the practice was seen to be clean and tidy.
• The practice had systems to keep patients safe including safeguarding procedures and means of sharing information in relation to patients who were vulnerable.
• Learning from incidents was apparent and we saw good examples of changes made as a result of learning.
• There were a range of appointments to suit most patients’ needs.
• Patients with palliative care needs were supported using the Gold Standards Framework.

• The practice had the appropriate equipment, medicines and procedures to manage foreseeable patient emergencies.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating February 2018 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Good

We carried out an announced comprehensive inspection at Pound Hill Medical Group on 28 November 2017. The overall rating for the practice was good. The practice was also rated good for the effective, caring and well-led domains and all the population groups. It was rated outstanding in providing responsive services. However, it rated was as requires improvement for providing safe services. The full comprehensive report on the November 2017 inspection can be found by selecting the ‘all reports’ link for Pound Hill Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 21 June 2018 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 2017. 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.

At our inspection of 28 November 2017, we found that:

• The provider had not ensured appropriate steps had been taken to monitor and record fridge temperatures.

• The practice had not ensured they had emergency medicines to cover all treatments carried out in the practice or demonstrated that these are not required through a risk assessment.

• The provider had not ensured the interventions provided for patients prescribed high risk medicines were always monitored in line with national guidance.

At this inspection our key findings were as follows:

• The provider had a system for monitoring high risk medicines in line with national guidelines.
• Emergency medicines were in place to cover all treatments.
• The fridge temperatures where monitored, recorded and audited.

Additionally we saw that:

The provider had reviewed the collation of responses to MHRA alerts and kept a central record that demonstrated actions and outcomes. These were discussed at practice meetings.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.