HHR Medical

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at HHR Medical on 25 May 2017. The overall rating for the practice was good but requires improvement for the key question: Are services safe? The full comprehensive report on the 25 May 2017 inspection can be found by selecting the ‘all reports’ link for HHR Medical on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 1 December 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 25 May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good and is now rated good for key question: are services safe?

Our key findings were as follows:

• There was a consolidated child safeguarding policy which included all relevant information including the name of the practice lead.

• The practice had systems in place to monitor handwritten prescriptions.

• The practice were now reviewing uncollected prescriptions monthly and recording action taken in response to the review.

• Printer prescriptions were stored in locked cabinets.

• The most recently published Quality Outcomes Framework data for 2016/17 showed that some scores relating to the management of patients with diabetes were still below local and national averages. For example the percentage of patients with well controlled blood sugar was 61% compared with 76% in the CCG and 80% nationally).The practice informed us that the nurse was due to start a diploma in diabetes.

• Performance had improved in respect of the percentage of patients with complex mental health conditions who had a care plan in place compared to the previous year (83% compared with 90% in the CCG and 90% nationally). However the percentage of patients with a record of alcohol consumption was still lower than local and national averages (75% compared with 91% locally and nationally). According to unverified performance data the practice had, as at 22 November 2017, completed mental health care plans for 90% of patients with complex mental health conditions for 2017/18.

• In 2016/17 the percentage of patients with dementia who had an agreed care plan in place was also now in line with local and national averages (86% compared to CCG and national average of 84%).

• In 2016/17 the percentage of patients with atrial fibrillation who met specific clinical requirements that were being treated with anticoagulation therapy was now in line with local and national averages (80% compared with 86% of the CCG and national average of 88%).

• Although we were not provided with any recent complaint response which included contact information for organisations that patients could escalate concerns to, the practice provided a leaflet with this information which we were told was available at reception and on the practice’s website.

• The percentage of patients who had bowel cancer screening in 2016/17 was in line with local averages (44% compared with 41% in the CCG).

  However, there was also an area of practice where the provider needs to make improvements.

The provider should:

• Continue with action to improve performance in respect of the management of patients with diabetes.

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 HHR Medical on 25 May 2017. 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 a system in place for reporting and recording significant events.
• In most respects the practice had clearly defined and embedded systems to minimise risks to patient safety. However, we were told that there was no formal system in place for reviewing uncollected prescriptions.
• Prescriptions held in printers were not locked away at the end of the day, though we were told that they were kept in locked rooms which were accessible to contract staff. There was no system in place for monitoring written prescription pads. We found 50 handwritten prescription pads secured in a lockable cupboard. We were told these were rarely used and that there was no system in place for monitoring their use.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However the latest available data from the Quality Outcomes Framework (QOF) showed that that the practice were performing below local and national averages in some indicators for the management of patients with diabetes, atrial fibrillation and mental health.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and 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.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

• Ensure that systems and processes are in place for the safe management of medicines; specifically the security and monitoring of prescriptions and for following up patients who have failed to collect their prescriptions.

The areas where the provider should make improvement are:

• Continue with action to improve performance in respect of the management of patients with long term conditions and those experiencing poor mental health.

• Consolidate information in child safeguarding documents into a single policy which is easily accessible to all staff.

• Supply contact information in complaint responses for external organisations patients can escalate complaints to if they are unhappy with the practice’s response.

• Promote bowel screening in an effort to encourage uptake.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice