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Inspection Summary


Overall summary & rating

Good

Updated 20 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harvey Group Practice on 30 November 2016. 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.
  • The practice had many clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. However some systems, processes and practices relating to medicines management were insufficient.
  • There were some procedures in place for monitoring and managing risks to patient and staff safety. However, at the time of our inspection the systems and processes in place relating to fire safety were insufficient.

  • 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.
  • The patients we spoke with or who left comments for us were very positive about the standard of care they received and about staff behaviours. They said staff were thorough, considerate, understanding and caring. They told us that their privacy and dignity was respected and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Most patients were positive about access to the practice and appointments. Some patients said getting an appointment in advance could be difficult and there could be a considerable wait to see a GP of their choice when making a pre-bookable appointment. However, they said that access to urgent and same day appointments was good.
  • 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 sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

  • Ensure an appropriate system is in place for the safe use and management of medicines including medical consumables and controlled drugs prescriptions.
  • Ensure that sufficient fire safety systems and processes are in place and adhered to.

The areas where the provider should make improvements are:

  • Take steps to ensure that hot water temperatures at the practice are kept within the required levels.
  • Ensure that all staff employed are supported by receiving appropriate supervision and appraisal and are completing the essential training relevant to their roles, including safeguarding, infection prevention and control and basic life support training.
  • Ensure that all GPs have sufficient knowledge of the Deprivation of Liberty Safeguards (DoLS) and that a DoLS register is in place.
  • Continue to identify and support carers in its patient population.
  • Continue to take steps to ensure that in future National GP Patient Surveys the practice’s areas of below local and national average performance are monitored and improved, including access to appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 11 September 2017

At our comprehensive inspection on 30 November 2016, we identified breaches of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided safe services. During our focused inspection on 15 August 2017 we found the provider had taken action to improve and the practice is rated as good for providing safe services.

  • A sufficient process was in place and adhered to for recording the collection of controlled drugs prescriptions.
  • Staff completed appropriate checks on the stock and expiry dates of all medicines and medical consumables.
  • Sufficient fire safety systems and processes were in place and adhered to. 
  • All staff had completed adult and child safeguarding, infection prevention and control and basic life support training within the required timescales.
  • Some cold and hot water temperatures recorded at both surgeries were outside the required levels. Following investigation of the causes of this, the practice was considering its options as to how best to proceed to resolve the issue. In the meantime, the practice had measures in place to assist in reducing any risks to staff and patients.

Effective

Good

Updated 20 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were above local and national averages. For example, performance for diabetes related indicators was above the CCG and national averages. The practice achieved 100% of the points available compared to the CCG average of 90% and the national average of 90%.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for staff. At the time of our inspection the system of appraisals for nurses and non-clinical staff was behind schedule. However, we saw evidence to show that all staff were scheduled to have an appraisal completed. Whilst some staff were overdue completing some essential training, the practice had a schedule in place to ensure this was completed. Despite this, all the staff we spoke with demonstrated they understood the relevant processes and their responsibilities.

  • Staff worked with multi-disciplinary teams to understand and meet the range and complexity of patients’ needs.
  • Staff sought patients’ consent to care and treatment in line with legislation and guidance. However, none of the GPs were aware that death certificates for patients on The Deprivation of Liberty Safeguards (DoLS) register should only be issued by a coroner and not a GP.

Caring

Good

Updated 20 March 2017

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in July 2016 showed that patients rated the practice similar to or slightly above local and national averages for all aspects of care.
  • 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.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice had identified 178 patients on the practice list as carers. This was approximately 1.4% of the practice’s patient list. Of those, none had been formally invited for and two (1%) had received a health review in the past 12 months. The number of carers receiving a health review could be improved.

Responsive

Good

Updated 20 March 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with NHS England and Herts Valleys Clinical Commissioning Group to secure improvements to services where these were identified.
  • Data from the National GP Patient Survey published in July 2016 showed that patients rated the practice a mix of below and above local and national averages for access to the practice. Senior staff at the practice were aware of the areas of below average satisfaction scores and could demonstrate they were responding to it.
  • Most patients were positive about access to the practice and appointments. Some patients said getting an appointment in advance could be difficult and there could be a considerable wait to see a GP of their choice when making a pre-bookable appointment. However, they said that access to urgent and same day appointments was good.
  • 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 and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 20 March 2017

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to this.
  • 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.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • During our inspection we found that some systems, processes and practices relating to medicines management and those relating to fire safety were insufficient. However, following their own proactive attempts to improve the practice’s internal systems and processes in the past six months, senior staff at the practice took immediate action to respond to the main areas of risk we identified during our inspection.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
  • The practice sought feedback from staff and patients, which it acted on. The Patient Participation Group was active.
  • There was a focus on continuous learning and improvement at all levels.
Checks on specific services

Older people

Good

Updated 20 March 2017

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
  • The practice provided comprehensive health assessments to housebound patients aged 75 years and over. The practice had identified 47 such patients and since April 2016, 30 (64%) had received their comprehensive assessments.
  • Older people had access to targeted immunisations such as the flu vaccination. The practice had 2,011 patients aged over 65 years. Of those 1,431 (71%) had received the flu vaccination at the practice in the 2015/2016 year. A further 33 patients were recorded as having received the vaccination elsewhere.
  • There were 17 care homes in the practice’s local area and patients of the practice resided in 15 of them at the time of our inspection. The GPs visited as and when required to ensure continuity of care for those patients. For one of the homes for residents with increased needs there were two scheduled visits each week. The practice provided six monthly reviews to all its patients living in care homes, including a full medicines review.

People with long term conditions

Good

Updated 20 March 2017

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • 74% of patients on the asthma register had their care reviewed in the last 12 months. This was similar to the CCG average of 75% and the national average of 76%.
  • Performance for diabetes related indicators was above the CCG and national average. The practice achieved 100% of the points available compared to the CCG and national average of 90%.
  • All newly diagnosed patients with diabetes were managed in line with an agreed pathway.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and a structured annual review (or six monthly review if they resided in a care home) to check their health and medicines needs were being met. For those patients with the most complex needs, the named GPs worked with relevant health and care professionals to deliver a multi-disciplinary package of care.
  • The practice had operated a nurse led prediabetes clinic since July 2016. In the first month of the programme, 26 patients were seen and provided with diet and lifestyle advice. After three months, 19 of the 26 patients returned for their repeat blood tests and monitoring and 14 (74%) of those had blood glucose levels (blood sugar levels) in the normal range. Also, more than half had lost weight.

Families, children and young people

Good

Updated 20 March 2017

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

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who may be at risk, for example, children and young people who had a high number of A&E attendances.
  • Immunisation rates were comparable to other practices in the local area for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • The practice’s uptake for the cervical screening programme was 80% which was similar to the CCG and national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • There were eight week post-natal checks for mothers and their children.
  • A range of contraceptive and family planning services were available.

Working age people (including those recently retired and students)

Good

Updated 20 March 2017

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

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • The practice offered online services such as appointment booking and repeat prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
  • There was some additional out of working hours access to appointments to meet the needs of working age patients. There was extended opening at Harvey House Surgery every Saturday from 8.40am to midday for GP and nurse pre-bookable appointments. There was no lunchtime closure at Harvey House Surgery.
  • The practice provided 15 minute appointment slots to all patients as standard.

People whose circumstances may make them vulnerable

Good

Updated 20 March 2017

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

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability. There were 71 patients on the practice’s learning disability register at the time of our inspection. Of those, all had been invited for and 49 (69%) had accepted and received a health review in the past 12 months.
  • The practice offered longer appointments for patients with a learning disability and there was a GP lead for these patients.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access 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.
  • Additional information was available for patients who were identified as carers and there was a nominated staff lead for these patients.
  • The practice had identified 178 patients on the practice list as carers. This was approximately 1.4% of the practice’s patient list. Of those, none had been formally invited for and two (1%) had received a health review in the past 12 months. The number of carers receiving a health review could be improved.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 March 2017

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

  • 98% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was considerably above the CCG average of 85% and national average of 84%.
  • Performance for mental health related indicators was above the CCG and national averages. The practice achieved 100% of the points available compared to the CCG average of 95% and the national average of 93%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access support groups and voluntary organisations.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • A dual qualified NHS and Improving Access to Psychological Therapies (IAPT) counsellor was based at Harvey House Surgery twice each week. Patients could access this service to obtain psychological and emotional counselling and advice through referral from the GPs.
  • There was a GP lead for mental health.