The Harefield Practice

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this. At this first assessment of the service since its registration with CQC, this key question has been rated as good because we did not find any issues with how the provider assessed the needs of the patient population. There were effective systems put in place to ensure the needs were identified timely and risks mitigated.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care wellbeing and communication needs with them. Patient feedback received through the CQC experience of care forms was very positive in how their needs were assessed and met. People felt involved in the assessment of their needs and confident that staff understood their individual and cultural needs. The practice provided 15 minutes consultations instead of 10 minutes to the patients and ensured a thorough triage using the phone system to ensure the patients who needed to see the GP were booked. The traveller community was established in the area and the practice, with strict observance of the data protection guidelines and safety, ensured patients from this community were seen by the GPs with support from their relatives.

The reception staff invited patients into the surgery who had difficulty using technology and supported them to use online systems (BLINXS) via a dedicated computer at the practice. Patients who were housebound were offered home visits. The practice gave longer appointments to patients with learning disabilities and there was a quiet room available for patients if needed. Preferred time of appointment was given to patients living with dementia.

The practice had a named carers’ champion. Health checks were offered to those eligible and some of the reviews completed. Staff informed us that some patients were opposed to vaccinations and were non-compliant with advice given by health professionals. The practice continued to engage and encourage the patient population to be involved in assessing their health needs. The service is located within a high number of smoking population. The practice had an initiative called “The Harefield Healthy Lung Project” designed to reduce the mortality and morbidity by detecting and diagnosing early any lung disease. The practice involved relevant stakeholders and there was a noticeable impact on the respiratory health of the patient population by the number of the patients that took the offer of spirometry and Fractional exhaled Nitric Oxide (FeNO) test using the equipment bought by the practice with support from the practice’s own smoking cessation team. Since the inception of the Healthy lung project, 94 patients used the service and 94 referrals to specialist services were avoided, however the end results of these lung checks were unknown to measure the impact on the health of the patients.

The service planned and delivered people’s care and treatment with them including what was important and mattered to them. This was done in line with legislation and current evidence–based good practice and standards. The staff were aware of the current evidence-based guidance and legislation. Our clinical searches showed that patient medication reviews and monitoring of long-term conditions were completed in line with current guidance. However, the searches showed that the coding of medication reviews and side effects of gabapentinoid prescribing needed to be reviewed. The practice did this following our site visit and updated the policy to reflect this, and learning was shared with the wider Primary Care Network (PCN).

The service worked well across teams and services to support people. They ensured people received care and treatment with support from relevant teams such as community nursing team, care home staff and shared learning and knowledge with the PCN. Staff had information to appropriately assess, plan and deliver effective service to the patient population. The staff worked in teams relevant to their roles and responsibilities and tasks delegated to appropriately trained staff and other services where needed.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and worked with local services and social prescribers. The practice supported 3 care homes and residents had personalised care plans. The practice developed an enhanced service for care homes in Harefield called “HACHES- the Harefield Additional Care Home Enhanced Service” to provide bespoke care to the care home patients. The service delivery included a named care home coordinator, a carers champion, a dementia champion, a care home pharmacist and a named GP for regular contact within the practice for each of the care homes. The practice met with all the care homes to discuss on a regular basis falls prevention strategy for care home patients living with dementia. The practice supported people to live healthier lives by actively encouraging the Harefield Healthy Walk. The practice identified a need to support some of the patient population who had controlled drug dependency. The practice designed, developed and implemented a new service in collaboration with ‘ARCH’, the local drug and alcohol service. The new service called ‘ARCHField’ supported the patient population to safely reduce dependency on prescribed medicines such as reliance on sleeping tablets and opiates, without the other local services being overstretched.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent and met the expectations of the people and clinical expectations. From our clinical searches of the patient records reviewed, patient outcomes followed evidence-based clinical guidance. The practice introduced a health pod located in a private area of the practice for patients to check their blood pressure, weight and height. In addition, the practice implemented additional training for staff in collaboration with a domestic violence support body called IRIS to recognise signs of domestic violence in patient population and escalate rapidly to the right team to support the patients who needed such services.

There were workshops for patients going through menopause. However, the practice was below the national targets for cervical cancer screening (practice 67.3%; national target 80.0%). The practice recognised there was a reluctance to engage with cervical screening from female patients of the travelling community. The practice continued to engage, encourage and educate patients on the benefits of this health check.

The childhood immunisation uptake at this practice was below the national target of 90% minimum. The practice attempted to increase uptake by educating parents and addressing misinformation about childhood immunisations and this improved uptake as highlighted by the practice.

The cancer detection rate at this practice (63.60%) did not vary from the national target (54.90%). The breast cancer screening at this practice was 74.20% which was slightly above the national average (70.40%).

The bowel cancer screening at this practice was 69.9% which was just below the national average (71.8%). The practice using its Safety Matrix dashboard ensured patients who were apprehensive and unaware of the benefits of this vital health screening were supported and informed, however, the impact on uptake remained to be seen. The practice after review of the report informed CQC that the Safety Matrix was used to continuously monitor and improve outcomes and the review of additional evidence we received did not yet show a measured impact on patient outcomes improvement.

The practice always carefully explained to people what their rights around consent were, ensured they fully understood them and fully respected these when delivering person-centred care and treatment. All the staff files we reviewed as part of the assessment process showed evidence of completion of the Mental Capacity Act 2005 training. Consent and capacity were clearly documented as seen by our review of the patient records. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions were recorded in line with relevant legislation. The relatives of the patients who lacked capacity and had the relevant authority to make decisions on their behalf were involved in their care.