Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hightown Surgery on 12 July 2016. Overall the practice is rated as requires improvement. Specifically improvements are required in providing safe and effective services.

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

• There was a system in place for reporting and recording significant events. Reviews of complaints, incidents and other learning events were thorough, but there was no overall formal review system for these.
• Risks to patients were mostly assessed and well managed. However, some risks were not fully managed, such as fire and legionella.
• Staff assessed patients’ ongoing needs and delivered care in line with current evidence based guidance.
• National data suggested patients mostly received appropriate care for long term conditions. However, exception reporting was very high and there was a risk that patients did not always receive care in line with national guidance wherever possible.
• The system for recording the review of patients on repeat medicines was not fully functional, but the practice had identified this and taken mitigating action.
• Staff were trained in order 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. 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.
• 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 and complied with the requirements of the duty of candour.
• There was a strong ethos of continuous learning.

Areas the provide must make improvements are:

• Ensure that patients’ care and outcomes are in line with guidance wherever possible by; reducing exception reporting to ensure that patients are only excepted where appropriate  and continue to identify ways of improving the monitoring of patients on long term medicines and repeat prescriptions.

Areas the provide should make improvements are:

• Formalise the process for reviewing learning outcomes from significant events and complaints.
• Ensure risks identified such as legionella and fire risks, are appropriately managed and acted on.
• Review the uptake of learning disability annual health checks

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at Hightown Surgery on 12 July 2016 found breaches of regulations relating to the safe and effective delivery of services. The overall rating for the practice was requires improvement. Specifically, we rated the practice as requires improvement for provision of safe and effective and good for providing caring, responsive and well-led services. Consequently we rated all population groups as requires improvement. The full comprehensive report from the July 2016 inspection can be found by selecting the ‘all reports’ link for Hightown Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused desktop inspection (we have not visited the practice but requested information to be sent to us) carried out on 16 February 2017. It was conducted 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. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. The information requested in February 2017 identified that the practice was meeting the regulation that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Overall the practice is now rated as good. Consequently we have rated all population groups as good.

Our key findings were as follows:

• The significant event procedures had been amended to introduce periodic reviews of incidents. This ensured any required changes to practice were embedded.
• Legionella and fire risk assessments had taken place and actions undertaken as a result of these assessments.
• There had been a significant reduction in exception reporting (exceptions are made when patients are not included in national data submissions regarding practice performance) since our previous inspection.
• The level of up to date medicine reviews had increased significantly since July 2016, improving the monitoring of patients on repeat medicines.
• Learning disability reviews were at 73% for the year which was up from 54% for the previous year found at our last inspection in July 2016.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice