We carried out an announced comprehensive inspection at Highbury Grange Medical Practice on 05 March 2019. The practice was previously rated as good overall in October 2017.

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 inadequate for providing safe services because:

• The service lacked appropriate protocols to ensure the safe prescribing of high-risk medicines.

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

• The practice did not have clear and effective governance processes for managing and monitoring patients being prescribed high risk medinces; patients being referred under the two week wait cancer referral service; and maintaining the internal child safeguarding register.

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

• Patients received effective care and there was a strong emphasis on continuous improvement.
• 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.

We rated the practice as good for all population groups.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way (Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Continue with efforts to improve the up-take of cervical screening.
• Continue with the new process of recording and following up patients who have been referred under two week wait referral service.
• Continue with the new process for keeping the practice’s safeguarding register up to date and in line with the child protection register.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Highbury Grange Medical Practice on 18 July 2017. We rated the practice as good for providing effective, caring, responsive and well-led services and the overall rating was good. We rated the practice as requires improvement for providing safe services, as we had concerns relating to infection prevention and control, medicines management and fire safety training for staff.

We served a requirement notice relating to the practice’s failure to comply with Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The full comprehensive report on the July 2017 inspection can be found by selecting the ‘reports’ link for Highbury Grange Medical Practice on our website at http://www.cqc.org.uk/location/1-543975260. After the inspection, the practice sent us a plan of actions it intended to take to ensure it was able to meet the legal requirements under the key question, Safe.

This inspection was an announced focussed inspection carried out on 24 October 2017 looking at the issues previously identified and to check and confirm that the practice had carried out its plan to meet the legal requirements. We found that the practice had taken appropriate action to meet the requirements of the regulations relating to providing a safe service, with regard to the safety issues we had identified. Accordingly, we have revised the practice’s rating in respect of providing a safe service to good.

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 of the Highbury Grange Medical Practice on 18 July 2017. Overall the practice is rated as good.

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

• Systems, processes and policies were not always reliable to keep people safe. These related to infection prevention and control issues, the use of Patient Group Directions by locum nurses and fire awareness training for staff.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Feedback from patients and the results of the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with urgent appointments available the same day.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the practice must make improvement are:

• Ensure care and treatment is provided in a safe way to patients. In particular that - appropriate levels of cleanliness are maintained in all areas, with cleaning being carried out in accordance with written schedules to allow monitoring; all staff members receive up to date training in infection prevention and control; Patient Group Directions in respect of locum nurses are completed correctly and validated; and all staff members receive annual fire awareness training.

The area were the practice should make improvement is:

• Continue with plans to improve and monitor outcomes for patients with long term conditions.

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 the Highbury Grange Medical Practice on 8 April 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, caring, safe and responsive services. The service was found to require improvement for providing an effective service. It was also good for providing services for the care provided to older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

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. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• 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.

There were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Ensure a programme of completed clinical audit cycles is undertaken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice