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Inspection Summary


Overall summary & rating

Good

Updated 21 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Old Harlow Health Centre on 05 November 2015. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
  • Data showed patient experience and satisfaction was good.
  • Information about services and how to complain was available and easy to understand.
  • Most patients said they found it easy to make an appointment, with urgent appointments available the same day.
  • 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 obtained and acted upon feedback from the ‘Friends of Old Harlow Health Centre’ group. This is not a Patient Participation Group (PPG) although the practice is in the process of setting up a PPG.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 January 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and investigating significant events.

  • Lessons were shared with the appropriate members of staff, including non-clinical staff, to make sure action was taken to improve safety in the practice.

  • Staff felt able to raise any concerns they may have.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

  • Staff worked with multi-disciplinary organisations to ensure adult’s and children’s safety.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 21 January 2016

The practice is rated as good for providing effective services, however there is an area where improvements should be made.

Data showed that patient outcomes were at or above average for the locality. The staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical audits that had been completed demonstrated quality improvement. Staff had the skills, knowledge and experience to deliver effective care and treatment.

The practice used a prescription clerk to update prescriptions once the practice had received discharge summaries. The system had protocols in place and a GP to check the prescriptions before authorising them. However the prescription clerk, other than initial in-house training, did not receive any formal support or ongoing training to complete this role. Any errors made were discussed informally. The level and content of the in-house training was not documented therefore it was not possible to determine how robust the in-house training was.

Clinical staff had received regular performance reviews. Non–clinical staff had not received regular formal performance reviews or formal supervision. All staff were however supported and encouraged to complete appropriate additional training.

The staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 21 January 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice higher than others for several aspects of care. For example, 91.1% of patients said that the last GP they saw or spoke with was good at giving them enough time, compared with 83.1% CCG average and 86.6% England average.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible, both within the practice building and online.

  • We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

  • The practice contacted newly bereaved families at a time convenient to them, even outside of usual surgery hours.

Responsive

Good

Updated 21 January 2016

The practice is rated as good for providing responsive services.

  • It reviewed the needs of its local population and engaged with the Clinical Commissioning Group and other local initiatives to secure improvements to services where these were identified.

  • The practice kept up to date with local developments within close proximity to ensure consideration and provision was made for the increased patient population.

  • Most patients said they found it easy to make an appointment, with urgent appointments available the same day, telephone consultations and pre-bookable appointment options.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • The practice responded quickly to complaints raised and investigated them appropriately. Learning from complaints was shared with relevant staff.

  • The practice obtained and acted upon feedback from the ‘Friends of Old Harlow Health Centre’ group.

    This is not a Patient Participation Group (PPG) although the practice is in the process of setting up a PPG.

Well-led

Good

Updated 21 January 2016

The practice is rated as good for being well-led.

  • The practice and staff had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. The partners encouraged a culture of openness and honesty which was evident when interacting with staff.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • All staff had received inductions and attended staff meetings and events, where they had the opportunity to provide feedback to the practice.
  • The practice had systems in place to monitor and respond to feedback provided by several sources including, ‘Friends of Harlow Health Centre’ group, from the GP survey and NHS Choices/Friends and family Test to improve outcomes for patients.

Despite the issues found surrounding non-clinical appraisals and some role specific training, there was a strong focus on continuous learning and improvement at all levels. The practice was a teaching practice with four GP trainers.

Checks on specific services

Older people

Good

Updated 21 January 2016

The practice is rated as good overall for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.

  • It was responsive to the needs of older people, and offered home visits and urgent appointments, as well as telephone consultations.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were comparable with other practices nationally. For example, the practice offered patients aged 65 and older a flu vaccination, and performed in line with the national average for uptake of this vaccination.

  • The practice held a yearly flu clinic on a Saturday when the practice was not usually open. The ‘Friends of Old Harlow Health Centre’ group had a coffee morning on the same day so it was a social event. The practice also invited support groups to this.

  • There was a working hearing loop at the front desk and an audible/visual display for calling patients to their appointments.

  • There was plenty of seating available both in the main reception area and outside the individual consulting rooms. There were a variety of chair options available including high back chairs with arms.

  • There was an automatic door so those requiring wheelchairs or smaller mobility scooters could access the surgery.

  • A room was made available to a visiting phlebotomy service, so patients could choose to have blood tests done at the practice instead of at the local hospital.

  • Patients were called in for a health check at 70 years old, which included a review of medical history and lifestyle advice.

  • There was access to a hearing advisory service within the practice building.

People with long term conditions

Good

Updated 21 January 2016

The practice is rated as good overall for the care of people with long-term conditions.

  • Nationally reported data showed that outcomes for patients for long-term conditions were comparable with other practices nationally. For example, numbers of patients with long-term conditions, such as diabetes receiving appropriate reviews were slightly higher than the national average.

  • Home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • A room was made available to a visiting phlebotomy service, so patients could choose to have blood tests done at the practice instead of at the local hospital.

  • Sign posting information for support groups was evident in the reception area.

Families, children and young people

Good

Updated 21 January 2016

The practice is rated as good overall for the care of families, children and young people.

  • There were systems in place to identify and follow up children who were at risk, for example, if GPs were concerned about the safety of children and young people, appropriate referrals were made and were necessary multi-agency case conferences held. Immunisation rates were relatively high for all standard childhood immunisations.

  • We found that GPs were aware that some children may have the ability to make decisions about their own treatment.

  • Nationally reported data showed that outcomes for patients for uptake of cervical smears were comparable with other practices nationally.

  • The practice held immunisation clinics for children and babies with two nurses present to mitigate any risks associated with the giving of immunisations. Should these clinics not be suitable bookable appointments were available outside of these times, when two nurses could be available.

  • The premises were suitable for children and babies.

  • A room was made available to a visiting phlebotomy service, so patients could choose to have blood tests done at the practice instead of at the local hospital.

  • Patients could access family planning advice and emergency contraception from any member of clinical staff throughout the surgery hours.

Working age people (including those recently retired and students)

Good

Updated 21 January 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The practice made available urgent appointment slots at the end of clinic.

  • Patients could have a telephone consultation if a face to face consultation was not required.

  • A room was made available to a visiting phlebotomy service, so patients could choose to have blood tests done at the practice instead of at the local hospital.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

  • The practice did not offer extended hours appointments.

People whose circumstances may make them vulnerable

Good

Updated 21 January 2016

The practice is rated as good overall for the care of people whose circumstances may make them vulnerable.

  • The practice had both temporary and permanent patients on their list from a nearby hostel/halfway house providing accommodation for vulnerable people.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • Practice nurses provided hour long annual reviews for those patients with a learning disability.
  • There were a variety of waiting areas available so if required a quieter waiting area would be available.
  • It had told vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
  • There was a working hearing loop at the front desk and an audible/visual display for calling patients to their appointments.
  • There was access to a hearing advisory service within the practice building.
  • Practice leaflets could be made available in a variety of languages. A translation service was available with notice and some of the GPs were multi-lingual.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 January 2016

The practice is rated as good overall for the care of people experiencing poor mental health (including people with dementia).

  • The amount of people diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, was comparable with the national average

    .

  • Patients with schizophrenia, bipolar affective disorder and/or other psychoses registered at the practice have a comprehensive, agreed care plan documented in their records.
  • The practice screened patients for dementia and referred to the memory clinic if the screening test was positive.
  • The practice had systems in place to ensure patients attended for reviews.
  • There were a variety of waiting areas available so, if required, a quieter waiting area would be available.