This practice is rated as Requires Improvement overall. (Previous rating January 2018 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires Improvement

We carried out an announced comprehensive inspection at Hornsey Park Surgery on 15 November 2018 to follow up concerns identified at our previous inspection on 10 January 2018.

In January 2018, we rated the practice as Requires Improvement for providing caring services (because national patient survey scores were below local and national averages) and rated the service as Good for providing safe, effective, responsive and well led services. Overall the practice was rated as Good.

At this inspection we found:

• Staff did not always appropriately assess, monitor or manage risks to people who used the service. For example, although a Legionella risk assessment had taken place, the practice had not undertaken the subsequent actions required to mitigate against identified risks.
• We saw evidence patients did not find it easy to raise complaints and when they did, they received an unsatisfactory response.
• Since our last inspection the practice had introduced an action plan to improve patient survey satisfaction scores on the extent to which doctors involved patients in care decisions. Latest comparable patient survey results showed that performance was still below local and national averages but we noted the survey took place only two months after the action plan’s introduction and therefore improvement activity might not yet have positively impacted on patient satisfaction scores.
• Patients told us that staff were kind, respectful and compassionate.

• Governance arrangements did not always operate effectively. The practice’s recruitment policy did not list staff pre-employment checks and the absence of a protocol for managing patient safety alerts meant roles and responsibilities were not clearly understood. Also, monitoring of patients on high risk medicines was not governed by a written protocol to ensure it was safe, timely and in accordance with best practice guidelines.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure specified information is available regarding each person employed.

The areas where the provider should make improvements are:

• Review protocols for ensuring that periodic defibrillator checks take place.
• Review arrangements for following up failed children’s appointments.
• Review arrangements for identifying patients with dementia.
• Review arrangements to improve cancer screening uptake rates.
• Review arrangements for developing and supporting Patient Participation Group led patient surveys.
• Review arrangements for managing complaints.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as good overall. (Previous inspection April 2016 – rated overall Good)

The key questions are rated as:

Are services safe? – good

Are services effective? – good

Are services caring? – requires improvement

Are services responsive? – good

Are services well-led? - good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – good

People with long-term conditions – good

Families, children and young people – good

Working age people (including those retired and students – good

People whose circumstances may make them vulnerable – good

People experiencing poor mental health (including people with dementia) - good

We carried out an announced comprehensive inspection at Hornsey Park Surgery on 10 January 2018 to follow up on a previous requirement notice issued for not ensuring there was a record of emergency medicines to ensure they were available.

At this inspection we found:

• The practice had taken some action in relation to the national patient survey since the last inspection, a number of the scores  in relation to the practice being caring were still below CCG and national averages.

• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However we found that mental capacity act training had not been undertaken by the GP. Evidence that this training had been booked was provided following the inspection.

• 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 said that they were involved in their care and decisions about their treatment.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• 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 requirement of the duty of candour.

The areas where the provider should make improvements are:

• Ensure that appropriate staff undertake mental capacity act Training.

• Continue to look at ways to improve national patient survey scores in relation to caring.

• Formalise plans for succession planning.

• Finalise practice business plan.

• Look at ways to re start 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 Hornsey Park Surgery on 14 April 2016. Overall the practice is rated as good.

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.
• Not all risks to patients were assessed and well managed. The practice did not have a system for checking that all emergency medicines were present and in date. 
• Data showed patient outcomes were comparable to the national average. Some audits had been carried out, and we saw some evidence that audits were driving improvements to patient outcomes.
• Patients said they were treated with compassion, dignity and respect.

• Information about services was available but not everybody would be able to understand or access it.

• The practice had a number of policies and procedures to govern activity, but some were standard policies that had not been adapted to be practice specific.

The areas where the provider must make improvements are:

• Ensure there is a system for checking emergency medicines.

In addition the provider should:

• Produce a finalised business plan.

• Review practice policies and procedures in order to make them relevant to the practice.

• Develop a plan to improve patient satisfaction scores.

• Review and develop an induction programme for new staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

When we inspected on 21 February 2014 we found the premises to be worn and looking unkept. No infection control audits were available. We found there was no suitable storage for medicines. The medicines fridge was unlocked and no temperatures recorded. We found that the walls were dirty and equipment was damaged.

We found no evidence of staff pre-employment checks including references and Disclosure Barring Service (DBS) checks. The practice complaints policy was not accessible to patients and the practice failed to respond to concerns appropriately.

We inspected the practice again on 10 September 2014 and found that infection control audits were present and up to date. Cleaning schedules were available for all areas of the practice. The medicines fridge was locked and accurate fridge temperatures being recorded. There was an appropriate medicines management policy.

We found that the premises had been refurbished with adequate built in storage and faulty equipment repaired or replaced. Building risk assessments were currently being carried out and a fire safety programme in place.

The practice was in the process of ensuring all staff had an up to date DBS check and all references had been obtained and placed in staff files.

The practice complaints policy was accessible in the reception area and complaints were being responded to in accordance with the policy, with complaints also being used as part of training exercise in team meetings.

The surgery had approximately 3500 patients on its register. The practice was open six days per week. There were four doctors working at the practice, one of which worked only one session per week. They were supported by the practice manager, three receptionists, a nurse and two administrative support staff.

The patients we spoke with told us that they were mostly happy with the services provided by the practice. However, we found that when patients raised concerns with the provider their comments and complaints were not always responded to appropriately.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. However, we noted that occasionally patients’ treatment had been delayed.

People were not protected from the risk of infection because the provider did not follow appropriate guidance. The provider did not operate effective systems designed to detect and control the spread of health care associated infection.

The provider did not have a sufficiently rigorous system of recording and monitoring of medicines stored at the service. We noted that stock and storage temperature had not been routinely monitored.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. The provider did not asses the risks associated with the use of premises.

The provider did not operate an effective recruitment procedure to ensure people employed for the purposes of carrying on a regulated activity were of good character and fit for that work.