Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Highlands Practice on 25 May 2016. The overall rating for the practice was Good. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Highlands Practice on our website at www.cqc.org.uk.

At our previous inspection on 25 May 2016, we rated the practice as requires improvement for providing safe services as the practice had not undertaken appropriate assessments for all for staff who acted as a chaperones and did not provide appropriate training for the role.

This inspection was a desk-based inspection carried out on 14 August 2017 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 25 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. At this inspection, we found that the practice had conducted Disclosure and Barring Service (DBS) checks on all staff who acted as chaperones. We asked the practice for evidence that they had ensured that non-clinical staff acting as chaperones received appropriate training, but we did not receive this evidence initially. Subsequent to further contact from the practice at a later date, we received the information requested relating to chaperone training of non-clinical staff. In addition, we saw that the practice staff had recently undertaken Information Governance and Data Protection Act training. The practice had identified 80 patients as carers, which equates to less than 1% of the practice list. As a result of these findings, the practice rating remains as good overall, with the key question of safe, changing from requires improvement to good. 

Our key findings were as follows:

• The practice had ensured that members of staff acting as chaperones had appropriate assessments for staff undertaking the role by way of DBS checks and the practice provided evidence that non-clinical members of staff conducting chaperoning had received appropriate training.

The areas of practice where the provider should improvements are:-

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is available to them.

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 Highlands Practice on 25 May 2016. Overall the practice is rated as Good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained 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.
• 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 practice was aware of and complied with the requirements of the duty of candour.

The areas where the practice must make improvement are:

• To assess that the appropriate assessments have been undertaken for staff who act as a chaperones and to provide appropriate training for the role.

The areas where the practice should make improvements are:-

• Ensuring all staff are aware of the requirements relating to Information Governance and Data Protection.
• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Highlands Practice is a general practice (GP) surgery that provides NHS services to a registered population of 9110 patients within the Enfield Clinical Commissioning Group (CCG) area.

Enfield CCG is a membership organisation of 54 local GP practices and is responsible for commissioning health services for a population of around 310,000 people. Census data showed that 38.8% of the population belong to non-white minorities which is more than three times higher than the England average (12.3%). Other White (18.2%), Black African (9.0%) and Black Caribbean (5.0%) are the biggest minority groups in the Enfield area.

Highlands practice operates from a single premises located within Florey Square and is currently registered with the Care Quality Commission (CQC) as a partnership of five GPs. We inspected the regulated activities of diagnostic and screening procedures, maternity and midwifery services, surgical procedures and treatment of disease, disorder and/or injury. The practice had a strong and visible leadership, with staff being clear about their roles and responsibilities

Most of the patients we spoke with and comment cards reviewed showed patients were very happy with the quality of care and treatment they had received. This included being treated with kindness and respect on most occasions, involvement in decision making about their treatment planning and delivery, and the cleanliness of the practice.

Most patients also told us they were very unhappy with the appointment service because the appointment availability for non-urgent medical needs was too long a wait, telephone access at 08:00 was difficult and continuity in care was not always maintained as they were unable to see their preferred doctor when needed. The practice was aware of these concerns and had taken action.

We found the GP practice provided a caring service for patients using the service and many aspects of the practice were responsive to patient needs. Most of the patients we spoke with were very complementary about the treatment and care received, and we observed positive interactions between patients using the service and staff.

Appropriate arrangements were in place in relation to involving patients in decisions about their care and service provision, safeguarding people from abuse, management of medicines and the maintenance of suitable equipment. The practice maintained good working relationships with local health community services and multi-disciplinary professionals to ensure appropriate care and treatment was delivered.

However, some improvements were required to ensure the practice provided a safe, effective and well-led service. For example, the practice did not have up to date and completed clinical audit cycles to inform the quality improvement process, appropriate checks had not been undertaken before staff began work to ensure patients were cared for by suitable staff and some records related to the management of the service and staff employed were not available for us to assess on the day of the inspection.