Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hodge Hill Family Practice on 9 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for older people; people with long-term conditions; families, children and young people; working age people; people whose circumstances may make them vulnerable and people experiencing poor mental health.

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.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Cleanliness and infection control was well maintained at the practice.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. We found that the practices audits were mostly driven by the medicines management team at the CCG (Clinical Commissioning Group). The practice recognised the need to conduct more clinical audits and they shared a summary of other audits due to be carried out at the practice.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned for. However, there was some inconsistency regarding awareness of lead roles within the practice. For example, some staff were unaware of the lead for safeguarding.
• Patients said they were treated with compassion, dignity and respect.
• Information about services and how to complain was available and easy to understand.
• There was a clear leadership structure and staff felt supported by management. Patients and staff told us how continuity of care was improving with permanent GPs in place; however we found that patients over the age of 75 did not have a named GP.

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

Importantly the provider should:

• Ensure processes are robust with regards to the management and dissemination of national patient safety alerts and ensure communication is consistent amongst clinical staff at the practice.
• Ensure risks to patients are assessed and recorded in relation to health and safety.
• Continue to strengthen a programme of clinical audits in the practice, ensuring that full cycle audits are completed with improvements recorded.
• Ensure support is offered to families who have suffered bereavement and ensure information is available for carers to offer support and signpost carers to local support services.
• Ensure a consistent approach is applied when applying learning points to complaints made regarding locum GPs who may fail to respond to complaints once they have left the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

At our last inspection in January 2014, most of the patients who we spoke with were not satisfied with the system for making appointments to see a GP. Patients who we spoke with told us that they were not able to get an appointment for their young children or make urgent appointments. Patients told us that they could not always get through on the telephone to make appointments. At the time of the inspection we judged that this had a minor impact on patients. We set compliance actions and told the provider to improve.

The purpose of this inspection was to see if improvements had been made since our last inspection in January 2014. We gave the provider short notice so that any disruption to people's care and treatment was minimised. During our inspection we spoke with nine patients including the parents of young children. We also spoke with three members of staff in administrative roles as well as the operational support manager and the director of operations. The registered manager as detailed in this report was also the practice manager. However, we did not get the opportunity to speak with them on the day of the inspection. We found that the provider had made the necessary improvements.

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. Patients spoken with were generally positive about the care and treatment that they received. One patient told us, "I have no problems with the care at the practice, I can get an urgent appointment when I need it and staff are very helpful".

Appropriate checks were completed before staff were employed at the practice to ensure they were suitable to work with children and vulnerable adults.

We visited the surgery in response to information of concern we had received. These concerns related to the management of medicines. On the day of the inspection we spoke with two GPs, a healthcare assistant (HCA), a practice nurse and three other staff including the operations support manager. The operations support manager had taken over the responsibilities of the practice manager who had been off long term and had recently returned. We also spoke with five patients about their experience including a member of the Patient Participation Group (PPG) who had come in specifically to speak to us.

Most of the patients we spoke with were generally happy with the level of care they had received and felt that it was generally safe and appropriate. One patient said: “The Surgery is good.” However, patients did not always get appointments in an emergency.

We found appropriate arrangements were being undertaken to manage the risks associated with the unsafe use and management of medicines.

We found that staff were supported in the roles they carried out and had regular appraisals to identify developmental opportunities. This meant that they had been adequately assessed as being competent.

The provider has system in place for monitoring the quality of service provision. We saw that the practice carried out a range of audits on a regular basis to monitor the quality of its own performance.