The Care Quality Commission
  • Doctor
  • GP practice

The Circle Practice

Overall: Good read more about inspection ratings

Belmont Health Centre, 516 Kenton Lane, Harrow, Middlesex, HA3 7LT (020) 8427 1213

Provided and run by:
The Circle Practice

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about The Circle Practice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about The Circle Practice, you can give feedback on this service.

28 April 2021

During an inspection looking at part of the service

We carried out a review of The Circle Practice on 28 April 2021. Overall, the practice is rated as Good.

Safe - Good

Effective - Good

Caring - Good

Responsive - Good

Well-led - Good

Following our previous inspection on 15 August 2019 the practice was rated Good overall and for the key questions safe, caring, responsive and well led and for four of the population groups (Older people; People with long-term conditions; Working age people; and People whose circumstances may make them vulnerable). The practice was rated Requires improvement for providing effective services and for the population groups Families, children and young people and People experiencing poor mental health.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Circle Practice on our website at www.cqc.org.uk

Why we carried out this review

This review was a focused review of information without undertaking a site visit to follow up on:

  • Uptake rates for childhood immunisations
  • Quality and outcomes framework data for mental health indicators
  • Staff training for health and safety and equality and diversity
  • Process for reviewing unplanned admissions

How we carried out the review

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our reviews differently.

This review was carried out by requesting documentary evidence from the provider and without visiting the location.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • information from our ongoing monitoring of data about services and
  • information from the provider and other organisations

We have rated this practice as Good for providing effective services and for the population groups Families, children and young people and People experiencing poor mental health.

We found that:

  • The practice had improved the systems for monitoring uptake rates for childhood immunisations. Data showed uptake rates had improved, although they remained below the national target.
  • Outcomes for mental health indicators were in line with local and national averages.
  • Health and safety and equality and diversity training had been undertaken by all staff.
  • The practice had improved their processes for reviewing unplanned admissions.

In addition;

  • Clinical staff had received updated safeguarding children and adults training relevant to their role.
  • Since the last inspection the practice’s cervical screening uptake rates had marginally increased from 61% in 2018/19, to 62% in 2019/20 (Public Health England data). There was then a gradual decrease in uptake rates to 58% in 2020. However, we have taken into account that cervical screening has been adversely affected during the current pandemic. We were also provided with evidence that the practice had made efforts to improve the call / recall system for eligible patients.

Whilst we found no breaches of regulations, the provider should:

  • Continue to improve childhood immunisation and cervical screening uptake rates

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

15 August 2019

During an inspection looking at part of the service

We carried out an announced focused inspection at The Circle Practice on 15 August 2019.

We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

We also followed up a breach in regulations identified at the previous inspection on 10 May 2018. At that inspection, we rated the safe key question Requires Improvement due to potentially unsafe administration of vaccines.

Following our review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions:

  • Is the service safe?
  • Is the service effective?
  • Is the service well-led?

Because of the assurance received from our review of information we carried forward the ratings for the following key questions:

  • Is the service caring?
  • Is the service responsive?

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 have rated this practice as Good overall.

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • The practice was able to show that staff had the skills, knowledge and experience to carry out their roles.
  • The practice was able to show that it always obtained consent to care and treatment.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centred care.

We rated the practice as Requires Improvement for providing effective services because:

  • Some performance data was significantly below local and national averages. The practice had taken some action but there was limited evidence of improvement at the time of inspection.

The areas where the provider must make improvements are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Maintain the practice training matrix to ensure all completed training is included.
  • Monitor staff completion of Health and Safety training in line with the practice’s training policy.

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

10 May to 10 May

During a routine inspection

This practice is rated as Good overall. (Previous inspection February 2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at The Circle Practice on 10 May 2018. The inspection was carried out to follow-up on a breach of regulations identified at our previous inspection. At this inspection we found:

  • The practice had systems to manage most risks so that safety incidents were less likely to happen.
  • We did find some safety risks however. For example, the practice was not ensuring the health care assistant was administering vaccinations with valid authorisation.
  • When incidents occurred, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients found the appointment system easy to use and reported that they could access care when they needed it.
  • There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

  • The practice must ensure that care is provided in a safe way to patients. This includes ensuring that medicines administered by the health care assistant are done so under valid patient specific directions authorised by a prescriber; ensuring it has an effective system to maintain the temperature of vaccines and any other medicines that require refrigeration. The practice must review its contribution to cervical screening failsafe arrangements and audit the sample takers’ rate of inadequate samples.

The areas where the provider should make improvements are:

  • The practice should continue to review its child immunisation performance and take action where appropriate to meet the national target.
  • The practice should review how it assures itself that all healthcare professionals working at the practice maintain their registration with the appropriate professional body.
  • The practice should review its infection prevention and control arrangements and clarify roles and responsibilities with all staff members.
  • The practice should review the programme of immunisation status checks and vaccination schedule offered to new staff members.
  • The practice should ensure it maintains an accurate register of patients with learning disabilities so that services can be appropriately tailored to these patients’ needs.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

5 February 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Circle Practice on 5 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, caring, responsive and well led services. It was also good for providing services for older people; families, children and young people; working age people (including those recently retired and students); people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia). It required improvement for providing effective services and services for people with long term conditions.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Systems including safeguarding measures and infection control procedures were in place to keep patients safe.
  • Staff were appropriately qualified to deliver effective care and treatment in line with professional guidelines.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
  • 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.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must:

  • Ensure Disclosure and Barring service (DBS) checks are undertaken for all staff who undertake chaperone duties at the practice or undertake a risk assessment if a decision is made not to perform DBS checks for staff providing chaperone duties.

The provider should:

  • Ensure all staff providing chaperone duties understand their role and responsibilities when providing the chaperoning service.
  • Ensure all patients with long term conditions are provided with a structured annual review to check that their health and medication needs are met.
  • Ensure there is a proactive recall system in place to provide preventative and continuing care for patients.
  • Ensure the practice business continuity plan provides a comprehensive list of contact details for staff to refer to.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice