We carried out an announced comprehensive inspection at Hillingdon Health Centre on 28 February 2019 as part of our inspection programme. The practice was previously inspected on 27 October 2017 and rated good overall. Although we we found no breaches of regulations, we found areas where the provider could make improvements. Specifically, we said the practice should arrange for staff to undertake basic life support training on an annual basis, continue to identify and support more patients who are carers and continue to encourage patients to join the patient participation group.

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 good overall and good for all population groups.

We rated the practice as good for providing effective, caring, responsive and well led 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 way the practice was led and managed promoted the delivery of high-quality, person-centre care.
• The practice had a culture which drove high quality sustainable care.

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

• The practice did not always follow guidance for the safe management of medicines. Specifically, patients prescribed with a medicine used to treat a mental health condition had not had blood tests within recommended timescales.
• Arrangements to manage prescription stationery did not include a process to track the use of blank prescription stationery throughout the practice so that theft or misuse could be identified.

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:

• Follow through with plans to update safeguarding training for clinical staff in line with national guidelines.
• Continue to ensure portable appliance testing and health and safety risk assessments are carried out within recommended timeframes.
• Continue to improve the uptake for childhood immunisations to achieve the national target of 90% or above in all four indicators.
• Continue with efforts to improve the uptake for cervical screening to achieve the national target of 80%.
• Improve the identification of carers to enable this group of patients to access the care and support they need.

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 at Hillingdon Health Centre on 11 July 2016. The practice was rated as requires improvement for providing safe, effective and well led services and good for providing caring and responsive services. The overall rating for the practice was requires improvement. The full comprehensive report for the inspection on 11 July 2016 can be found by selecting the ‘all reports’ link for Hillingdon Health Centre on our website at www.cqc.org.uk.

This inspection was a follow up desk based focused inspection carried out on 27 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 11 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated good for providing safe, effective and well led services and the overall rating is now good.

Our key findings were as follows:

• Safety incidents were documented, investigated and lessons learnt shared with practice staff.
• Infection prevention and control risks were identified and managed through annual audit.
• Suitable arrangements were in place to deal with emergencies and major incidents.
• There was evidence of quality improvement activity including clinical audit.
• Consent forms were used to confirm patients’ agreement to minor surgical procedures.
• There was a process for the recording of verbal complaints received and the actions taken in response.
• The practice continued to encourage patients to join the Patient Participation Group (PPG).

We also reviewed the actions taken since the last inspection where we identified areas that the practice should make improvements.

Our findings were as follows;

• Since our last inspection some improvement had been made to the number of patients the practice had identified and included on the carer’s register which had increased from 30 to 59 patients (0.4% to 0.8% of the practice list size). The practice had implemented additional processes to assist in the identification of patients who were carer’s, including forms at reception for patients to complete. They also aimed to identify other carers during the flu campaign season and had arranged for a representative from a local carers charity to attend some flu clinics to promote support services available.
• The practice had installed a hearing loop in the reception area to assist any patients with hearing impairment.

The areas where the provider should make improvement are;

• Arrange for staff to undertake basic life support training on annual basis.
• Continue to identify and support more patients who are carers.
• Continue to encourage patients to join the patient participation group.

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 Hillingdon Health Centre on 11 July 2016. Overall the practice is rated as requires improvement.

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

• Although there was an open and transparent approach to safety and an effective system in place for reporting and recording significant events, there was no evidence to demonstrate how these were shared with the rest of the team and how lessons were learnt to make improvements.
• Not all risk assessments were performed and gender specific health advice was not always documented as offered to patients.
• Although the practice had good facilities and was well equipped to treat patients and meet their needs, some aspects relating to infection control were not well met and there was no hearing loop available for patients with impairment.
• There was no consistent governance system in place to monitor the operations of the practice and inform on required improvements.
• 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, although there was no system in place to record and deal with verbal complaints.
• Patients did not always find it easy to make an appointment with a named GP however, there was continuity of care with urgent appointments available the same day.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff through meetings and patients through patient surveys, which it acted on.

The areas where the provider must make improvements are:

• Ensure safety incidents are systematically recorded, investigated and learning shared with staff to prevent a reoccurrence.
• Ensure that infection prevention and control measures are effective and subject to annual audit and that there are appropriate waste disposal arrangements in all areas of the practice.
• Ensure there is a programme of quality improvement including clinical audit to inform improvements in patient outcomes.
• Ensure there is an effective governance system that identifies areas for improvement and ensures lessons are learnt. For example, reviewing complaints to identify and analyse trends and monitor and facilitate all staff training and development.

The areas where the provider should make improvements are:

• Ensure risk assessments are undertaken and managed in all cases.
• Consider installing a hearing loop for those who are hard of hearing.
• Review systems in place to identify patients with caring responsibilities in order to offer appropriate advice and support.
• Review how verbal complaints are recorded and dealt with in the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice