Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Hart Surgery on 17 October 2016. Overall the practice is rated as good. However, requirements were required in providing effective services. Our key findings were as follows:

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

• There was a system in place for reporting and recording significant events and for learning to be circulated to staff and changes implemented where required. Reviews of complaints, incidents and other learning events were thorough.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ ongoing needs and when they delivered care to patients it was in line with current evidence based guidance.
• The practice was performing well on most clinical outcomes in terms of national data. However, national data suggested diabetic patients did not always access reviews of their conditions or meet standards of managing their care in line with national guidance. The practice had worked at improving this.
• There was very low exception reporting of patients indicating that the practice was reluctant to exclude patients from their data even if they did not attend for health reviews. The practice worked actively to encourage patients to attend for their health reviews rather than exception report on the basis of three contact attempts.
• Reviews of patients on repeat medicines were not always recorded properly to ensure this system was monitored properly and this had not been identified as an area for improvement or further monitoring.
• The practice planned its services based on the needs and demographic of its patient population.
• Patients’ feedback suggested they felt well cared for and supported.
• Staff were trained in order to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patient feedback on the appointment system was used to make improvements regarding access.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the duty of candour.
• There was an ethos of continuous learning and improvement.

Areas the provide must make improvements are:

• Improve the processes for monitoring patient care to ensure improvements are made where necessary. Specifically, improve the monitoring and recording of medicine reviews, mental health physical checks and learning disability checks.

Areas the provide should make improvements are:

• Undertake further assessment and relevant testing for legionella to mitigate the risk of infection.
• Continue the work aimed at improving the care outcomes for diabetics.

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 Hart Surgery on 17 October 2016. The practice was rated as requires improvement for providing effective services. The overall rating for the practice was good. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for The Hart Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 3 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good for providing effective services.

Our key findings were as follows:

• The practice had improved the process for monitoring patient care through monthly searches of patients, to identify reviews and interventions due. This ensured patients received effective care at the right time.

• Medicine reviews had been undertaken for 99% of all patients on a repeat prescription.

• Improved uptake of physical health checks for patients on the learning disability and mental health registers had supported patients to lead healthier lives.

• The practice had reviewed their care provision for diabetic patients through new initiatives and stakeholder engagement. Diabetes care indicators had improved, particularly in relation to blood pressure targets for patients on the diabetes register.

The practice had contracted an external stakeholder to undertake a legionella risk assessment. Whilst the assessment had been undertaken in February 2017, the practice was only in receipt of the official report in June 2017. Some high risk actions were identified which the practice had reviewed and commenced acting upon. For example, water flushing and water temperature recording commenced in July 2017.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice