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Inspection Summary

Overall summary & rating


Updated 3 October 2018

We carried out an announced comprehensive inspection at Highcroft Surgery on 16 March 2016. Overall the rating for the practice was requires improvement and the practice was asked to provide us with an action plan to address the areas for improvements. A second announced comprehensive inspection was carried out on 3 November 2016 in order to review progress made by the practice. The practice was given an overall rating of good, with a rating of requires improvement for providing responsive services.

We carried out a third comprehensive inspection on 2 August 2017, which was announced at short notice to assess the areas previously highlighted as requiring improvement and respond to concerns reported by stakeholders about access to the service. During the inspection on August 2017, the practice was given an overall rating of good, with a rating of requires improvement for providing responsive services. The previous inspection reports can be found by selecting the ‘all reports’ link for Highcroft Surgery on our website at

This inspection was an announced follow up inspection carried out on 8 August 2018. This was to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations identified at the previous inspection. This report covers our findings in relation to those requirements.

Our key findings were as follows:

  • The practice had taken action to improve patient satisfaction in relation to accessibility and monitored this through surveys and audits
  • Feedback from patients and data reviewed showed improvements were being achieved to the appointment system, waiting times and getting through to the practice by telephone.
  • However, access to appointments was an ongoing issue and further plans were in place to increase availability by recruitment and collaborative working with local practices as part of a GP federation.
  • We identified that the practice took appropriate action to information received from the Medicines and Healthcare Regulatory Agency (MHRA). However, the practices process for documenting this was not appropriate to demonstrate this. We told the provider that they should improve the process.

The areas where the provider should make improvements are:

  • Ensure the recording of alerts received from the Medicines and Healthcare Regulatory Agency (MHRA) clearly reflects the actions taken and the outcomes achieved.

  • Continue acting to improve patient satisfaction in relation to access to appointments.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Inspection areas



Updated 14 September 2017

  • The practice had systems for reporting and recording significant events. Lessons were shared to ensure action was taken to improve safety in the practice.

  • The practice followed effective recruitment procedures to ensure all staff had received the appropriate pre-employment checks.

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

  • Risks to patients and staff were assessed and well-managed including procedures for infection control and other site-related health and safety matters. For example, the practice had a designated infection control lead who undertook regular audits and took action to address any issues that were identified.

  • Risks to vulnerable patients with complex needs were monitored by multi-disciplinary team meetings to provide holistic care and regular reviews.

  • Actions were taken to review any medicines alerts received by the practice to ensure patients were kept safe. However, the process did not demonstrate that actions required had been completed by the relevant clinicians.

  • The practice had effective systems in place to deal with medical emergencies.



Updated 14 September 2017

  • The practice had achieved an overall figure of 93.9% for the Quality and Outcomes Framework in 2015-16. This was in line with local and national averages. Practice supplied data showed overall achievement had improved to 98% in 2016-17; although this data is yet to be verified and published.

  • Staff assessed needs and delivered care in line with current evidence based guidance, and had regular clinical team meetings.

  • Patients received regular reviews of their condition to ensure their needs were being fully met.

  • Clinical audits were used to ensure ongoing quality improvement and patient safety.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. There was a process to support the training and development of all practice staff.

  • The skill mix and capacity of the practice team was kept under review to meet the changing demands upon GP practices. For example, a practice nurse and a health care assistant had commenced working in the practice team since our previous inspection.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs, in order to deliver care more effectively. Monthly meetings with wider members of the healthcare team were held to review more complex and vulnerable patients.



Updated 14 September 2017

  • The most recent results from the National GP Patient Survey in July 2017 showed that patient satisfaction with regards to GP consultations had marginally changed since the previous results. This included patients being given sufficient time to explain their problems, being listened to by the GP, and being treated with care and concern, which had all improved on average by less than 10%.

  • We observed that staff treated patients with kindness and respect on the day of our inspection.

  • The practice team would usually contact bereaved relatives and carers to offer condolences and support, including signposting to appropriate services such as bereavement counselling.

  • The practice had a carers champion to assist in the identification and support for carers. The practice had identified % of their registered patients as being carers.



Updated 3 October 2018

We previously carried out an announced comprehensive inspection at Highcroft Surgery on 2 August 2017. At the time the practice was rated as requires improvement for providing responsive services as the results from the published national GP patient survey highlighted that some responses were below local and national averages in relation to access. Although we found that the practice had made some changes to improve access, at the point of our inspection, the practice was unable to demonstrate sustained improvement and increased satisfaction in this area. During this inspection, we rated the practice as good for providing responsive services because action had been taken to address areas of low satisfaction and feedback identified that patient satisfaction was improving.

Timely access to care and treatment

The practice had responded to the results of the last national GP survey published in July 2017 and previous CQC inspections. The main areas identified for patient dissatisfaction related to access to appointments and getting through to the practice by telephone. The practice had taken a number of actions to increase accessibility for patients. This enabled patients to access care and treatment within an acceptable timescale for their needs. For example,

  • The practice had implemented a same day service known as the ‘Sit and Wait’ clinic where patients could be seen without an appointment. The practice had reviewed the impact this had and found it was viewed positively by patients and had a high uptake. This was aligned with feedback that we received from patients as well as NHS choices and the practices internal survey.
  • Patients reported that general routine and urgent appointments were easy to access.
  • More patients were able to get through to the practice by telephone in a timely manner and this was supported by recent data provided by the practice.
  • Waiting times, delays and cancellations were monitored and managed appropriately through data collection and auditing.
  • Patients told us that any delays in accessing appointments and waiting times on arrival were mostly due to patients wanting to see a preferred GP or that patients with urgent need were prioritised. Patients found these delays acceptable and stated that when they were seen they felt their care and treatment needs were met.
  • We looked at the 2018 national GP survey results which was published following our inspection although, we did not make a direct comparison to the previous survey or comparison with the local or national averages. This was due to a change in the survey methodology in 2018. However, the overall feedback received from patients demonstrated that patients experience of accessing the service had improved.
  • Following the inspection the practice had analysed the results in brief and noted improvements in patients getting through to the practice by telephone and the length of time patients waited on arrival to be seen. This was aligned with evidence from the inspection. However, access remained an area for improvement based on the results of the 2018 survey.
  • The practice had a proactive PPG and worked collaboratively with them to improve the service for the benefit of patients.

Please refer to the evidence tables for further information.



Updated 14 September 2017

  • The practice had a vision and mission statement accompanied by a practice development plan. Regular business meetings ensured effective oversight of key management issues and practice developments.

  • The practice engaged with the CCG and worked with other practices within their locality.

  • The practice had developed a range of policies and procedures to govern activity

  • The practice had regular clinical and staff meetings evidenced by documented minutes.

  • There was a clear staffing structure in place. Staff told us the management were accessible and supportive.

  • The practice had an active patient participation group (PPG) who were influential in championing patient views whilst being supportive to the practice.

Checks on specific services

People with long term conditions


Updated 14 September 2017

  • Patients with a long-term condition received an annual review to check their health and medicines needs were being appropriately met. Multiple conditions were reviewed at one appointment, and consultation times were flexible to meet each patient’s specific needs.

  • The practice had adopted an electronic toolkit called Arden’s in March 2017, to use alongside their computer clinical system to aid them in the management of long term conditions. The toolkit provided clinicians with templates which enabled them to view integrated information for patients with multiple conditions and manage them effectively.

  • Clinical staff would review patients at home if they were housebound or lived in a residential or nursing home.

  • For those patients with the most complex needs and associated risk of hospital admission, the practice team worked with health and care professionals to deliver a multidisciplinary package of care.

  • The practice worked with the independent pharmacists based in the same building who performed blood pressure checks to promote information sharing and improve their identification of patients with hypertension, in order to manage them effectively.

  • The local diabetes nurse specialist attended the practice to undertake joint clinics with the practice nurse to review patients with more complex needs, and undertook the initiation of insulin treatment in the community. Links were established with other specialist nurses such as the respiratory nurse to access expert advice and support when indicated.

  • QOF achievements for clinical indicators were mostly in line with local and national averages. However, the practice achieved 78.5% for diabetes related indicators, which was 9.7% below local averages, and 11.4% below the national average. This was a reflection on the loss of many nursing staff last year. However, we observed that new staff were addressing the situation effectively and that outcomes were on course to show significant improvements by the end of the current year. Practice supplied data showed achievement had improved to 95% in 2016-17, although the data was yet to be verified and published.

Families, children and young people


Updated 14 September 2017

  • Same day appointments were provided for babies or children who were unwell, and

  • The practice provided ante-natal care in conjunction with the midwife, and undertook new born and six-week baby checks.

  • The practice had an identified lead GP for child safeguarding. The public health practitioner (formerly known as health visitor) attended a monthly meeting with the lead GP to review and discuss any child safeguarding concerns. The practice made use of the close proximity with the practitioner who was based in the same building to share information as needed.

  • Immunisation rates were mostly in line with, or above, local and national averages for all standard childhood immunisations.

  • Nurse led clinics provided contraceptive services and advice. The community health service provider held evening clinics within the building once a week to enable access to a full range of family planning services.

  • The premises were suitable for children and babies. A child’s play area was available in the waiting area. The environment provided easy access for young mothers with prams and pushchairs.

  • The practice had baby changing facilities, and a play area was available for children. The practice welcomed mothers who wished to breastfeed on site, and offered a private room to facilitate this if requested.

Older people


Updated 14 September 2017

  • The practice offered personalised care to meet the needs of older people. Monthly multi-disciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs.

  • The practice accommodated the needs of older people, and offered home visits, longer appointments, and urgent appointments for those who needed them.

  • The advanced nurse practitioner was experienced in the care of older people and the management of multiple health conditions. The nurse worked with the local community health care of the elderly physician, and undertook regular reviews of patients with complex needs to reassess their treatment plans and needs, including prescribed medicines.

  • The practice provided primary medical services to residents living in three local care homes for older people. Following our last inspection,

Working age people (including those recently retired and students)


Updated 14 September 2017

  • Same day access clinics were offered on Monday, Tuesday and Friday from 8am to 10.30am where patients could attend appointments without booking them in advance. The practice also offered telephone advice by the on call GP.

  • The practice offered on-line booking for appointments and requests for repeat prescriptions. Participation in the electronic prescription scheme meant that patients on repeat medicines could collect them directly from their preferred pharmacy.

  • Extended hours appointments with GPs and the nursing team were available on two evenings each week until 7.30pm.

  • The practice provided NHS health checks for 40-75 year olds to identify any potential health problems and promote healthy lifestyles.

  • The practice’s uptake for the cervical screening programme was 88.3%, which was slightly higher than the CCG average of 86.2% and above the national average of 81.8%. Breast cancer screening rates were however lower in comparison to local and national averages.

  • Flu clinics were offered at a weekend and in the evening to improve access to vaccinations for working patients.

People experiencing poor mental health (including people with dementia)


Updated 14 September 2017

  • 72.1% of people diagnosed with dementia had had their care reviewed in a face to face meeting during 2015-16. This compared to a CCG average of 88.5% and a national average of 84%. Practice supplied data showed this had improved to 90.5%, although the data is yet to be verified and published.

  • The practice actively screened for memory problems to detect early symptoms of dementia and referred patients to the memory clinic for further investigations. Advance care planning was incorporated into reviews for patients with dementia.

  • The practice achieved 74.9% for mental health related indicators which was below the CCG average of 94% and the national average of 92.8%. The achievement in the previous year had been 100%. The practice explained that this was due to changes in staffing establishment, and that one of the newly appointed advanced nurse practitioners was now the nominated lead for mental health and was undertaking work to improve performance. The practice told us achievement for 2016-17 had improved to 97.7%, although this data was yet to be verified and published.

  • The practice regularly worked with multi-disciplinary teams in the management of people experiencing poor mental health. This included the dementia outreach team to support patients in a care home setting and a consultant psychiatrist.

  • The practice told patients experiencing poor mental health about how to access services including talking therapies and various support groups and voluntary organisations. Patients could self-refer to these services. Information was available for patients in the waiting area and the practice website to facilitate this.

People whose circumstances may make them vulnerable


Updated 14 September 2017

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability. Homeless people and refugees could register with the practice.

  • The practice regularly worked with multi-disciplinary teams and external organisations in the case management of vulnerable people. Patients and their carers were informed how to access various support groups and voluntary services.

  • There were 62 patients on the learning disabilities register, and 30 had already received an annual review since April 2017, with plans in place to review the remaining 32 patients before the end of the year.

  • The practice had a designated lead for safeguarding adults. Staff knew how to recognise signs of abuse in vulnerable adults, and were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies during normal working hours and out of hours.

  • The practice provided care and support for end of life patients, including advanced care planning to ensure that any care preferences were accounted for. Patients were reviewed in conjunction with the wider multi-disciplinary team and the practice worked within high quality standards for end of life care. The practice shared patient end of life care plans with other service providers to promote continuity of care and avoid unnecessary hospital admissions. One of the GPs used his specialist experience in end of life care to influence changes in palliative care protocols used in the local area.

  • Double appointment could be booked to ensure sufficient time was available to discuss individual needs. For example, when patients required access to interpreter services. Subsequent appointments were usually allocated to the same clinician to ensure continuity.

  • The practice had appointed a carers’ champion and had created a carers’ notice board in the waiting area.