Background to this inspection
Updated
1 May 2020
Highbury Grange Medical Practice is a GP practice located in the London Borough of Islington and is part of the NHS Islington Clinical Commissioning Group (CCG).
The practice is located in a residential area which is accessible by local bus and train services. The practice is located on the ground floor with step free access.
The practice provides care to approximately 9100 patients. The practice area population has a deprivation score of 5 out 10 (1 being the most deprived). The practice serves a higher than average number of working age patients. The practice cares for a diverse population with approximately 30% of its patients from Black and ethnic minority backgrounds.
The practice holds a GMS (General Medical Services) contract with NHS England. This a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract.
The practice is registered with the Care Quality Commission to provide the regulated activities: Diagnostic and screening procedures; Treatment of disease, disorder or injury; and Maternity and midwifery services.
The practice team consists of three GP partners (two male and one female), one male and two female salaried GPs, two female practice nurses, a practice manager and an administrative and reception team.
The practice’s opening hours are 9am to 6:30pm on weekdays, with GP extended hours appointments operating between 6.30pm-8.30pm Thursdays.
Standard appointments are 10 minutes long, with double appointments available to patients who request them, or for those who have been identified with complex needs.
The practice has opted out of providing an out-of-hours service. When the practice is closed, patients are redirected to a contracted out-of-hours service. The local Clinical Commissioning Group has commissioned an extended hours HUB service, which operates across three locations. The HUB sites operate from 6.30pm to 8pm on weekdays and 8am – 8pm on weekends. Patients may book appointments with the hub service by contacting the practice.
Updated
1 May 2020
We carried out an announced comprehensive inspection at Highbury Grange Medical Practice, on 5 March 2019, and rated the practice as inadequate for safe, requires improvement for well-led and good for effective, caring; and responsive. This gave the practice an overall rating of requires improvement. The full comprehensive report on the March 2019 inspection can be found by selecting the ‘all reports’ link for Highbury Grange Medical Practice on our website at . Because of the safety concerns we identified in managing and monitoring patients on high-risk medicines, we served a warning notice under Section 29 of the Health and Social Care Act 2008, as the provider was failing to comply with the relevant requirements of Regulation 12, (1), Safe care and treatment, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
At the inspection, on 5 March 2019
- We rated safe as inadequate because the practice had not provided care and treatment in a way that kept patients safe. In particular, we found there was unsafe and inappropriate management and monitoring of patients prescribed high-risk medicines. We also found concerns regarding the accuracy of the practice’s safeguarding register and there was not a safe system for monitoring patients referred under the two-week wait cancer referral service.
- We rated well-led as requires improvement because there was a lack of systems and processes established and operated effectively to identify or manage the above issues.
We carried out a warning notice follow-up inspection, on 18 July 2019, to assess whether the concerns identified in the warning notices had been addressed by the provider. At that inspection we found that the provider had appropriately addressed all the concerns identified in the warning notices and was providing safe care to patients on high-risk medicines.
We carried out a focused inspection, on 24 October 2019, the inspection focused on the safe and well-led key questions. At that inspection, we were satisfied the practice had addressed all previous concerns and we rated safe and well-led as good.
This inspection was carried out remotely on 11 March 2020. The lead inspector conducted a telephone interview with the practice manager. We determined the rating of all five key questions using a combination of evidence provided during the telephone interview, pre-inspection information sent by the practice, and the evidence collected from the three previous inspections held in 2019.
We rated the practice as good for providing safe, effective, caring, responsive and well-led services. This gave the practice an overall rating of good.
We based our judgement of the quality of care at this service on a combination of:
- What we found when we inspected;
- Information from our ongoing monitoring of data about services; and
- Information from the provider, patients, the public and other organisations.
We rated the practice as good for providing safe services because:
- The practice provided care and treatment in a way that kept patients safe and protected them from avoidable harm.
- There was safe and effective monitoring and management of patients that were prescribed high-risk medicine.
- There was safe and effective monitoring of patients referred under the two-week cancer referral system.
- There was safe and effective monitoring of patients on the child safeguarding register.
We rated the practice as good for providing effective services because:
- Patients received effective care and there was a strong emphasis on continuous improvement.
We rated the practice as good for providing caring services because:
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
We rated the practice as good for providing responsive services because:
- The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
We rated the practice as good for providing well-led services because:
- Systems and processes had been established and operated effectively to ensure compliance with requirements to demonstrate good governance and safe care and treatment.
We rated all the population groups as good, except for working age people which we rated as requires improvement, this is because the practice cervical screening uptake rate was well below the national target of 80%.
The areas where the provider should make improvements are:
- Continue with efforts to improve the up-take of cervical screening.
- Continue with efforts to improve the up-take childhood immunisations.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care