This practice is rated as Good overall.

(Harambee Surgery is a new registered practice and this is the first inspection of this service under this provider.)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Harambee Surgery on 4 April 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:

• 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.
• Safety systems were comprehensive and actions were taken to prevent legionella occurring in the water system (legionella is a term for a particular bacterium which can contaminate water systems in buildings). However, there was no evidence of the original risk assessment for this.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured care and treatment was delivered according to evidence- based guidelines.
• Clinicians had access to appropriate information to deliver safe care and treatment. We saw that some staff were removing some items of post without the GP having had sight of them and without a protocol for this or audit of the process. We saw that these items were few and of minor clinical importance and the practice said they would address this.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported they were able to access care when they needed it. Patient feedback on the care and treatment delivered by all staff was overwhelmingly positive.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice:

• The practice had appointed staff to champion and support the care certain patient groups received. They had appointed a patient dementia champion who consulted with patients and their carers to improve the practice premises; changing fixtures and fittings to become more dementia-friendly. Another staff member was appointed compassion champion who worked closely with children and vulnerable patients visiting the practice. We saw many examples of feedback from children and parents to say how much they valued this input and that their visit to the practice was a positive experience because of it.
• The practice had worked with patients who attended the local accident and emergency (A&E) department to try to ensure that all such attendances were appropriate. We saw evidence of reducing patient attendances at A&E over a period of nineteen months up to the time of our inspection.

The areas where the provider should make improvements are:

• Continue to develop a workflow protocol to deal with communications coming into the practice and an audit process to ensure compliance.
• Following the new legionella risk assessment to be carried out, confirm that the mitigating actions currently being completed are appropriate.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice