We carried out an announced comprehensive inspection at The Andover Health Centre Medical practice on 7 February 2019.

At this inspection we also followed up on breaches of regulations identified at a previous inspection on 11 April 2018, where the practice was rated requires improvement overall.

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 but we have rated the practice as requires improvement for providing safe services.

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

• The practice’s safeguarding policies did not reflect the risks of patients accessing online services.
• Staff recruitment or induction policies were not fully embedded.
• A Patient Group Directive (PGD) had not been authorised and immunisations were found to have been given under this PGD without the appropriate authorisation. This oversight had been highlighted as an issue at the practice’s previous inspection in April 2018.
• The practice had not formalised its repeat prescribing process to assure itself that the processes that staff were following were appropriate and safe.

We rated the practice as good for providing effective services because:

• We saw evidence of clinical audits which demonstrated improvements in clinical care.
• The practice organised and delivered services to meet patients’ needs.
• Unverified data provided by the practice demonstrated improvements to its Quality and Outcomes Framework results in all but one population group.

We rated the practice as good for providing caring, responsive and well-led services because:

• 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.
• The practice had a clear and credible strategy for providing sustainable care.
• Areas for improvement had been identified by the practice following its previous inspection and we saw evidence of actions plans in place to drive these improvements.

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:

• Continue to improve the identification of carers to enable this group of patients to access the care and support they need.
• Continue to improve QOF indicator outcomes and exception reporting to allow patients to access effective care.
• Continue to improve the uptake for cervical screening to achieve the national target of 80%.
• Continue to encourage and review patient feedback to monitor patient satisfaction.
• Review how the practice maintains full oversight of staff training and records of completion.
• Review how policies and procedures are consistently implemented regarding staff recruitment and induction.
• Review how actions from safety alerts are recorded and shared with temporary clinicians.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

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

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of The Andover Health Centre Medical Practice on 27 November 2014. The practice is situated at Charlton Road, Andover, Hampshire. SP10 3LD. The practice is a training practice for GPs.

The practice is rated as good overall.

Our key findings were as follows:

• Patients were able to access appointments via telephone, online or in person. Extended pre bookable appointments were offered each day from 7.30am with GPs and nurses.
• Patients told us they were treated with respect and treatment and care options were explained to them.
• There were suitable systems in place to protect patients from harm and staff were aware of the need to report any safeguarding concerns they had.
• Arrangements were in place to minimise the risk of cross infection. The practice had a contract to provide palliative care to a local hospice; GPs carried out ward rounds on week days.
• Alerts were placed on patient records that had type one diabetes to check for coeliac disease. (Coeliac disease is a lifelong autoimmune disease caused by intolerance to gluten).
• The practice were not always made aware of a woman’s pregnancy as communication was not effective between the practice and the midwifery service. GPs said that midwives had agreed to send information on a weekly basis to the practice but this had not occurred and this issue was ongoing.
• Palliative care meetings were held every two months and attended by Macmillan nurses and on occasion a consultant in palliative care.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Provide safeguarding adults training for all staff relevant to their roles.
• Include information when responding to complaints about access to advocacy services, the Parliamentary Ombudsman or the role of NHS England in complaints handling.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice