This practice is rated as Outstanding overall. (Previous inspection May 2015 – Outstanding)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Outstanding

Are services well-led? - Outstanding

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 – As the number of patients in this group was low we did not rate this population group

People with long-term conditions – Outstanding

Families, children and young people – As the practice did not provide services to this group we did not rate this population group

Working age people (including those recently retired and students – Outstanding

People whose circumstances may make them vulnerable – Outstanding

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

We carried out an announced comprehensive inspection at The Doctor Hickey Surgery on 8 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear 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.
• A proactive approach to anticipating and managing risks to people who use their services was embedded and was recognised as the responsibility of all staff.
• 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.
• The continuing development of the staff’s skills, competence and knowledge was recognised as being integral to ensuring high-quality care. Staff were proactively supported and encouraged to acquire new skills and share best practice.
• Staff involved and treated patients with compassion, kindness, dignity and respect. Patients were truly respected and valued as individuals and were empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients. Staff recognised that patients need to have access to, and links with, their advocacy and support networks in the community and they supported patients to do this.
• Services were tailored to meet the needs of individual patients and were delivered in a way to ensure flexibility, choice and continuity of care.

• The practice had a clear vision which had quality and safety as the top priorities. High standards were promoted and owned by all practice staff with evidence of team working across all roles.
• The strategy and supporting objectives and plans were stretching, challenging and innovative, while remaining achievable. Strategies and plan were aligned with plans in the wider health economy, and there was a demonstrated commitment to system-wide collaboration and leadership.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. There was a fully embedded and systematic approach to improvement. Improvement was seen as the way to deal with performance and for the organisation to learn.

We saw several areas of outstanding practice including:

• At our previous inspection in May 2015 we reported that the practice had entered into a partnership with a local food business who provided sandwiches daily for their patients. We found this partnership was continuing at our latest inspection. Patients we spoke with told us they especially welcomed this hospitality and the hot drinks provided daily at the practice.
• Since the previous inspection the practice had secured funding from a local community health charitable trust to provide patients with vouchers for ‘Health and Wellbeing Packs’ to meet the most immediate needs of rough sleepers. The packs contained items including food vouchers, basic clothing, toiletries, sleeping bags, dental and podiatry hygiene packs, wellbeing and local services information, and simple medicines, including analgesics and vitamins for patients.
• The practice continued to run the Street Doctor Program which was in place at our previous inspection. This was a medical outreach project where GPs and practice staff alongside the City Council outreach teams would carry out night walks through the local streets and parks. They spoke with rough sleepers, identified their medical needs and addressed those needs in ways which were likely to improve both their general health and their ability to utilise general homelessness services, with the ultimate aim of permanent resettlement. The practice regarded entrenched rough sleepers, people who have been rough sleeping for a long time, usually because of major psychoses, as especially vulnerable. They required prolonged and patient engagement, which the practice provided in association with the Westminster City Council specialist outreach service for entrenched rough sleepers.
• The practice participated in a Homeless Health Peer Advocacy project commissioned by Central London CCG which aims to help improve the health of currently homeless people - primarily through charity based Peer Advocates offering one to one support to help access health services by accompanying people to appointments. Advocates all have personal experience of homelessness and are recruited from existing volunteering schemes or are people who are interested in developing a career in the health and social care field. Two trained advocates were based at the practice and the practice told us utilising this service had greatly assisted its ‘inreach’ program to the major hostels and day centres in South Westminster.

The areas where the provider should make improvements are:

• Review progress on the arrangements for an externally provided health and safety check of the practice premises and equipment to ensure its completion and implementation of actions identified.

• Review the practice’s infection control policy to consider the inclusion of the assessment of patients with presumed sepsis and raising awareness among the reception team of symptoms that might be reported by patients and how to respond.
• Continue to review cervical screening uptake with a view to securing further improvement.

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 The Doctor Hickey Surgery on 7 May 2015. Overall the practice is rated as outstanding.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

• The practice had a Street Doctor Program which was a medical outreach project where GPs and some practice staff would carry out night walks through the local streets and parks. They spoke with rough sleepers, identified their medical needs and addressed those needs in ways which were likely to improve both their general health and their ability to utilize general homelessness services, with the ultimate aim of permanent resettlement.

• The practice employed an in-house drug and alcohol counsellor who was available five days a week and a general counsellor one day a week. They would see both booked and walk-in patients. They would see up to nine patients a day.

• The practice had entered into a partnership with a local food business who provided sandwiches daily for their patients. Patients we spoke with told us this was sometimes the only food they ate for days.

However there were areas of practice where the provider should make improvements:

• The practice should ensure chaperone training is undertaken for all members of staff who perform these duties.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice