Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall. (Previous inspection May 2016 – Good)

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? – Requires Improvement

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 – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

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

We carried out an announced comprehensive/focused inspection at Harraton Surgery on 11 January 2018 as part of our inspection programme.

At this inspection we found:

• The practice systems to manage risk required review to ensure that risks were more effectively identified and managed. We found that when incidents did happen, the practice learned from them and improved their processes.
• Quality Outcomes Framework (QOF) for 2016/17 showed the practice had achieved 99.5% of the points available to them for providing recommended treatments for the most commonly found clinical conditions.
• The practices governance system did not always support clinical effectiveness. We saw that these arrangements did not always ensure that care and treatment would be delivered according to evidence-based guidelines. Clinical staff had access to guidelines but the arrangement to ensure all staff were aware of changes were not clear. The arrangements to ensure all clinical staff acted in line with guidance on the management of sepsis were not effective.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Most patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice had merged with another local practice operated by the same provider on 4 October 2017; they were not able to demonstrate that they had a plan in place to manage the changes required within the practice.

The areas where the provider must make improvements are:

• Ensure care and treatment are being provided in a safe way for service users. (See Requirement Notice Section at the end of this report for further detail).

• Ensure effective systems and processes are in place to ensure good governance in accordance with the fundamental standards of care. (See Requirement Notice Section at the end of this report for further detail).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a previous announced inspection of this practice on 22 September 2015. Breaches of legal requirements were found. Overall, we rated the practice as inadequate. After the comprehensive inspection the practice wrote to us to say what they would do to address the identified breaches.

We undertook this comprehensive inspection to check that the practice had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Harraton Surgery on our website at www.cqc.org.uk.

Overall, the practice is rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had improved access to training 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had taken action to address the concerns raised at their previous CQC inspection. They had developed a clear vision, strategy and plan to deliver high quality care and promote good outcomes for patients.
• The provider was aware of and complied with the requirements of the duty of candour.
• We found the practice needed to further develop their approach to staff and patient engagement, to foster an open culture, where staff felt able to express their views and were confident that they would be acted upon.

There were also areas where the practice should make improvements. The practice should:-

• Consider the practice approach to appraisal so all staff have the benefit of a collaborative appraisal, which clearly identifies performance and learning needs.
• Continue with the progress made with staff training to address any remaining gaps, to ensure staff have the knowledge and skills needed to do their job.
• Consider how they can ensure the sustainability of improvements made and have robust and effective succession planning in place.
• The practice should continue to improve their approach to seeking and acting on feedback from patients and staff, to demonstrate continuous improvement and that they are a ‘listening’ organisation.

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 Harraton Surgery on 22 September 2015. Overall the practice is rated as inadequate.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings were as follows:

• The practice carried out assessments and treatment in line relevant and current evidence based guidance and standards.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• Patients said they felt involved in decisions made about their care and treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day, although some felt they waited too long to be called in for their appointment.
• Staff said managers were approachable but they were not involved in discussions about how to run and develop the practice, or encouraged to identify opportunities to improve the service delivered by the practice.
• When things went wrong, reviews and investigations were not sufficiently thorough and lessons learned were not communicated widely enough to support improvement .
• Staff had not received the training necessary to carry out their roles effectively.

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

Importantly, the provider must:

• Put effective systems in place to manage and monitor the prevention and control of infection.
• Take action to ensure the fridges used for storing vaccines are fit for purpose and minimum and maximum temperatures are checked.
• Ensure that there are formal governance arrangements in place, including systems for assessing and monitoring the quality of the service provision. Staff must have appropriate policies and guidance to carry out their roles in a safe and effective manner This should include putting in place a practice specific safeguarding policy for staff to follow.
• Provide appropriate training for all staff, including training on fire safety, infection control, safeguarding and information governance.
• Review staffing levels within the administrative and cleaning staff teams to ensure sufficient staff are deployed. This should include ensuring that appropriate numbers of staff are trained to complete referral letters.

In addition the provider should:

• Update the business continuity plan to include relevant contact details and reference to current NHS organisations.
• Ensure that recruitment information is available for each person employed.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate 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 to varying the terms of their registration within six months if they do not improve. The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harraton Surgery on 21 February 2019.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 11 January 2018 when the practice was rated as requiring improvement overall.

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.

We have rated this practice as requires improvement overall.

We rated the practice as requiring improvement for providing safe services because:

• Whilst the practice had taken steps to address issues identified during our inspection in January 2018 in relation to the provision of a safe service we found during this inspection that they did not have appropriate systems in place for the safe management of medicines.

We rated the practice as requiring improvement for providing well-led services because:

• Whilst the practice had taken steps to address issues identified during our inspection in January 2018 in relation to the provision of a well-led service we found during this inspection that they did not have a clear vision supported by a credible strategy to provide high quality sustainable care.

We rated the practice as good for providing effective, caring and responsive services because:

• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review the practice home visit policy to clearly reflect that requests for home visits should be assessed by a clinical member of staff.
• Continue with plans to establish an effective patient participation group and seek members views on the running and development of the practice.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice