Background to this inspection
Updated
1 September 2020
Holly Tree Surgery provides personal medical services to approximately 6,192 patients and has an in-house practice dispensary. The practice is part of North East Hampshire and Farnham clinical commissioning group (CCG) and a member of the federation of GP practices across all of North East Hampshire and Farnham locality. They are also a part of a federation of five Farnham GP services which also formed the Farnham primary care network in July 2019.
The registered provider is Holly Tree Surgery. The practice is registered to provide the following regulated activities: Treatment of disease, disorder or injury, Surgical procedures, Family planning, Maternity and midwifery services and Diagnostic and screening procedures.
The practice and dispensary are located at:
42 Boundstone Road, Wrecclesham, Farnham, Surrey, GU10 4TG.
The practice has three GP partners and three salaried GPs. Between them, they offer 30 sessions and a whole time equivalent (WTE) of 3.33 full time GPs. The nursing team consists of two part time practice nurses (WTE 1.06) and one part time healthcare assistant (WTE 0.21).
The dispensary is managed by a dispensary manager who is a qualified dispenser. There are four further qualified dispensers and three assistant dispensers.
Day-to-day operations are managed by a full time practice manager, a personal assistant to the practice manager, two secretaries and seven reception/administration staff.
The practice is open Monday to Friday from 8am until 6.30pm.
Prior to the COVID-19 pandemic, the practice operated a sit-and-wait, same day access system, for patients to see a GP. There were no pre-bookable GP appointments. Patients could access the sit-and-wait system for morning clinics and afternoon clinics. Due to the COVID-19 pandemic in March 2020, the practice ceased to operate the sit-and-wait service and now operate a largely telephone and video based consultation service.
The dispensary operating hours are Monday to Friday from 8.30am to 12.30pm and from 2pm to 6.15pm.
Extended hours services are provided by the federation of five Farnham practices from a different location and operates from Monday to Friday between 6.30pm and 8pm and on Saturday mornings.
Out of hours GP services are provided by an external stakeholder. Patients can access the out of hours service by contacting the NHS111 telephone service.
The practice population is situated in an area of low deprivation. Levels of employed patients is similar to local and national averages, whilst levels of unemployment are above the local average and in line with the national average. There is a high white British population of 96.5% with only 3.5% of patients deriving from black or minority ethnic groups. Average life expectancy was higher for the population compared with local and national averages.
The practice has been inspected before. You can find the previous practice reports by clicking on the link for Holly Tree Surgery and then the “all reports” section on our website: www.cqc.org.uk.
Updated
1 September 2020
We carried out an announced comprehensive inspection at Holly Tree Surgery on 6 November 2019 to follow up on breaches of regulation found in a previous inspection. We rated the practice as Good overall, however we found a further breach of regulation and rated Well led as Requires Improvement. You can read the full report by selecting the ‘all reports’ link for Holly Tree Surgery on our website at .
We were mindful of the impact of the Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what type of inspection was necessary and proportionate, this was therefore a desk-based review. On 17 July 2020, we carried out the desk-based review to confirm that the practice had carried out its plan to meet the legal requirements in relation to the breach of regulations that we identified at our inspection in November 2019.
We found that the practice is now meeting those requirements and we have amended the rating for this practice accordingly. The practice is now rated Good for the provision of Well led services. We previously rated the practice as Good for providing Safe, Effective, Caring and Responsive services.
We based our judgement of the quality of care at this service on a combination of:
- what we found when we reviewed the information sent to us by the provider
- information from our ongoing monitoring of data about services and
- information from the provider.
We have rated Well led as Good because:
- After the last inspection the practice had reviewed their arrangements for monitoring waiting times for the “sit and wait” system for GP appointments. They had undertaken an audit of waiting times in March 2020 to establish any areas of risk.
- Due to COVID-19, the “sit and wait” service had been temporarily suspended in March 2020 and a new system of telephone consultations was commenced. This had enabled reception staff to identify priorities of care and treatment, where previously this had not been undertaken for the “sit and wait” system (due to confidentiality in the reception and waiting area).
- The practice had sent a health questionnaire to all staff (including new starters) to determine if any reasonable adjustments were required to their work. The COVID-19 pandemic had resulted in some staff requiring to shield at home and not enter the workplace. They were given flexibility in working from home with remote access.
- Risk assessments of the practice and dispensary had been carried out to identify any risks to security.
- There had been two further infection prevention and control (IPC) audits carried out since the last inspection. The audits highlighted continuing concerns with the standards of cleaning and the practice was in regular communication with the contract cleaners to improve this outcome.
The practice had also made improvements since the last inspection in the following areas:
- The practice had commenced, and was in the process of, collecting information about staff immunisation status to inform them of any risks to patients, visitors or staff. They had reviewed the guidance in “the Green book” and had commenced with gaining clinical staff information first. We saw a spreadsheet of staff immunisations and where gaps were being followed up by the practice.
- The practice had implemented a system to support collecting informal verbal complaints and other feedback. They had placed books in the reception area, in all clinical rooms, with the medical secretaries and in the dispensary for staff to write in, to capture feedback that was not a formal complaint. The system had only been in place since March 2020 (at the start of the COVID-19 pandemic) and there had been no reported informal verbal complaints or feedback for the practice team to review for themes or trends.
- The practice had developed a system to recall patients on the learning disabilities register for annual health checks. A member of staff was responsible for undertaking the searches, contacting the patients and sending out an “easy read” patient information leaflet to request information from the patient (or their carer) before the appointment. The system was implemented in April 2020, but due to the restrictions in GP services with the COVID-19 pandemic, had been put on hold. The practice was looking to commence recall for patients on the learning disability register from August 2020.
The areas where the provider should make improvements are:
- Continue to monitor and review consent seeking processes to ensure accurate records are kept and consent is gained in line with guidance.
- Continue to collate staff immunisation status to inform any risks to patients, visitors or staff.
- Continue to include and engage with staff groups to improve communication.
- Continue to monitor and maintain oversight of cleaning standards and any related infection control issues.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care