Archived: High Road Family Doctors

Updated 21 October 2016

High Road Family Surgery is a practice located in a residential area in Benfleet, Essex. At the time of our inspection the practice had a list size of approximately 3860. The town has good commuter links and the immediate vicinity has some restricted on-road parking for patients.

The practice has two male GP partners, two female nurses, a practice manager, a team of administrative staff and a cleaner. At the time of our inspection, one GP partner was retiring within a few days, the remaining GP was becoming an individual provider and a new salaried GP was due to commence employment.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.30am to 11.30am every morning and 3.30pm to 6.30pm daily, with the exception of Thursday afternoons when appointments are not available, there is a duty GP who would see patients at this time if it

was an emergency. The practice is able to offer patients appointments at weekends through the GP Alliance, these appointments were at an alternative location in the locality.

When the practice is closed patients are directed to out of hour’s services by calling 111. These services are provided by Integrated Care 24.

Updated 21 October 2016

Letter from the Chief Inspector of General Practice

On 2 December 2015, we carried out a comprehensive announced inspection. We rated the practice as requires improvement overall. The practice was rated as requires improvement for providing safe, effective, caring and responsive services and inadequate for providing well-led services. Where a practice is rated as inadequate for one of the five key questions or one of the six population groups it is re-inspected within six months after the report is published.

At this time we identified several areas of concern including:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews and investigations were not always thorough enough. People did not always receive a verbal and written apology in a timely manner.
• The practice regularly engaged with other agencies to discuss patient needs, for example multidisciplinary meetings; however patient records were not always updated with care plans.
• The national GP patient survey, published in July 2015, showed that patient satisfaction was below local and national averages.
• The practice did not have a completed Legionella risk assessment in place.
• Not all clinical staff had a thorough understanding of the Mental Capacity Act (2005), or Gillick competency.
• The practice did not have arrangements in place to deal with bereavement and patients would not be routinely contacted following bereavement.
• The practice did not have a PPG in place.
• The practice held emergency medical equipment and drugs, however this was not all kept together and not all staff knew the location.
• There was insufficient leadership capacity within the practice. There was not an effective system to share information between all staff in the practice.

We re-inspected and carried out an announced comprehensive inspection at High Road Family Doctors on 25 August 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 a system in place for reporting and recording significant events. Record keeping had improved and patients were responded to in a timely manner.
• Risks to patients were assessed and well managed, since our last inspection a Legionella risk assessment had been completed.
• Emergency equipment had been improved since our last inspection and all staff knew of its location. Emergency medicines kept in the treatment room were stored securely and were in date; however some medicines found in a GP bag were out of date.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Multidisciplinary care was taking place and care plans were updated accordingly.
• Since our last inspection, in-house training had improved staff understanding of the Mental Capacity Act and Gillick competency.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment; data from the GP patient survey published in July 2016 demonstrated a significant improvement in patient satisfaction with the care received and access to services since our last inspection. However, data did show patients were waiting a significant amount of time after their appointment time.
• The practice were routinely implementing their own bereavement policy
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear staff structure; however there were no adequate systems in place to cover staff absences.
• Whilst the practice had a vision and ideas for the future, there was no strategy or business plan in place to demonstrate how this would be achieved. The practice had identified several staff due to retire but did not have succession planning in place.
• The practice had a number of policies in place to govern activity; however some were overdue a review.
• We were told staff morale had improved since our last inspection and staff felt supported by management.
• The practice had not been able to form a patient participation group but was still trying to engage patients and planned to form one as soon as possible.

The areas where the provider should make improvement are:

• Ensure emergency medicines held in GP home visit bags are in date and suitable for use.

• Develop a strategy or business plan for the future of the practice including succession planning.

• Develop a patient participation group.

• Review practice policies to ensure they are up to date.

• Improve the system in place when there is a need for staff cover during absences.

• Improve patient satisfaction regarding the time waited after their appointment time.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 October 2016

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.
• Nationally reported data showed that outcomes for patients with diabetes were above local and national averages; for example 82% of patients with diabetes, on the register, had their last IFCC-HbA1c as 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015), this was above the CCG average of 75% and the national average of 78%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 21 October 2016

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 were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were comparable to local averages for all standard childhood immunisations.
• Staff understood how to treat children and young people in an age-appropriate way and demonstrated to us how these patients were recognised as individuals. Staff understood Gillick competency and had undertaken in-house training since our last inspection.
• Cervical screening rates for the practice were above local and national averages; 89% of women aged 25-64 had a record in their notes to show that a cervical screening test had been performed in the preceding 5 years (01/04/2014 to 31/03/2015), this was above the CCG average of 87% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 21 October 2016

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

• The practice offered 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.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, such as hypertension and atrial fibrillation, were above local averages.

Updated 21 October 2016

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 was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice utilised SMS messaging and telephone appointments to improve access to services.
• The practice was a member of the local GP Alliance which offered patients, who could not attend appointments during normal working hours, appointments at the weekend.

Updated 21 October 2016

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

• Nationally reported data showed that outcomes for patients experiencing poor mental health were generally above local and national averages. Exception reporting for these indicators was higher than expected, however we were satisfied that patients were being appropriately exception reported.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 21 October 2016

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.
• The practice offered longer, flexible appointments for patients with a learning disability; the practice was proactive in offering these patients health checks.
• The practice regularly worked with other health care to ensure the multidisciplinary care of vulnerable patients.
• The practice informed vulnerable patients about how to access various 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. Since our last inspection, additional training had been undertaken on subjects such as vulnerable adults and the Mental Capacity Act 2005.