This practice is rated as Good overall. (Previous rating 10/2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Hilltops Medical Centre on 26 November 2018. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice had some clear systems to manage risk so that safety incidents were less likely to happen. However, there were some areas that were in need of strengthening. In particular, risks in relation to infection prevention and control needed review. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients we spoke with reported some difficulties with the appointment system and reported that they were not always able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements is:

• Ensure care and treatment is provided in a safe way to patients. (Please refer to the requirement notice section at the end of the report for more detail).

The areas where the provider should make improvements are:

• Provide appropriate non-clinical staff with training on sepsis.
• Undertake regular fire drills.
• Implement the newly developed appraisal system and complete staff appraisals for all staff in line with practice policy.
• Embed newly adopted processes for ensuring practice oversight of clinical registrations
• Continue with efforts to improve patient satisfaction and performance in the national GP patient survey; with particular regard for patient experience during consultations.
• Complete the proposed auditing of practice policies and procedures to ensure they are up to date and relevant.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hilltops Medical Centre on 27 May 2016. Overall the practice is rated as good.

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

• The practice had an open and transparent approach to safety, including the reporting and recording significant events.
• Risks to patients were assessed and generally well managed. However, we found that the medication review process neded to be more robust.
• The system for cascading and implementing medical updates and alerts would benefit from review. Evidence to identify the action the practice had taken in response to updated guidance and thereafter updating records was not always clear.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, we noted that not all clinical staff had a comprehensive understanding of the requirements to establish parental responsibilities before treatment was provided.
• 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.
• Feedback from patients was positive about the care and approach from staff. However, some identified concerns regarding accessibility of appointments. We saw that urgent appointments were 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, with partners and senior managers providing supportive and proactive direction for the practice. We noted that the CQC Registered Manager position was vacant at the time of inspection. The provider was in the process of applying for a new manager to be appointed.
• Staff told us they felt supported by the partners and senior management. The practice routinely sought feedback from staff and patients from a variety of sources, which it acted on to improve services.
• The provider was aware of and complied fully with the requirements of the duty of candour and had created and maintained a duty of candour log.

The areas where the provider should make improvement are:

• Ensure robust systems and processes are in place for management of patient safety alerts and medication reviews, to ensure all discussions and actions are recorded appropriately
• The practice should continue to monitor and seek improvements in outcomes for the National Patient Survey.
• Consider a documented business plan to support the practice vision and strategy.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice