Archived: High Road Family Doctors

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