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Huntingdon Road Surgery Requires improvement

Reports


Inspection carried out on 4 December 2019

During a routine inspection

This practice is rated as Requires Improvement overall. At the previous inspection in May 2016 the practice was rated as Outstanding overall.

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.

This inspection focused on the following key questions:

Are services at this location safe?

Are services at this location effective?

Are services at this location caring?

Are services at this location responsive?

Are services at this location well-led?

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.

  • Information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall.

The practice was rated as requires improvement for providing safe services because:

  • We saw that portable appliance testing (PAT) was not carried out by a qualified person to ensure electrical equipment was safe to use. The provider told us that visual checks were completed by practice staff. However, no documentation was provided to demonstrate staff had the competency for this role. Following the inspection, the practice informed us PAT had been booked for January 2020.
  • We found that fire and health and safety risk assessments were generic and lacking in detail specific to the practice premises. This did not provide assurance that all potential risks had been identified by the provider.
  • The practice provided examples of infection prevention and control audits. However, these audits did not cover the entire practice premises and the most recent audits in several areas were last undertaken in 2016.
  • The practice did not provide evidence clinical staff had complete oversight of relevant blood test results prior to prescribing warfarin. Following the inspection, the practice told us a new system had been implemented to ensure warfarin was only prescribed following receipt of a relevant blood test result.
  • We found that the system for monitoring prescription stationery was not effective at the branch site.

The practice was rated as requires improvement for providing effective services because the population groups of people with long-term conditions and working age people were rated as requires improvement. These population groups were rated as requires improvement because:

  • We found the practice had a higher Quality Outcomes Framework exception reporting rate for all long-term condition indicators; some of which were significantly higher than the Clinical Commissioning Group (CCG) and England averages. The practice were aware of this data; however, there were no plans to reduce the number of exceptions made.
  • The practice’s cervical screening uptake was significantly lower than the 80% Public Health England target rate at 54.4%.

In addition to these findings, we found:

  • Not all staff had received an appraisal in the last 12 months. We found that three members of staff had not received an appraisal since June 2018 and ten appraisals scheduled for October 2019 had not taken place at the time of inspection. Following the inspection, the practice provided evidence that all staff appraisals had been completed.

The practice was rated as good for providing caring, responsive and well-led services.

We also found that:

  • The practice had clear safeguarding processes and procedures; staff we spoke with were knowledgeable about safeguarding and the practice’s systems.

  • The practice had implemented a clear system of roles and responsibilities within the practice. Staff we spoke with were clear on these roles and responsibilities and who to approach for individual issues.

  • Arrangements for dispensing medicines at the practice kept patients safe.

  • The practice’s uptake of childhood immunisations was above the 90% World Health Organisation target rate.

  • Patient satisfaction through the National GP Survey was positive and most indicators were above the CCG and England averages. This was further evidenced through CQC comment cards received during the inspection and through patient consultations on the day of the inspection.

  • Staff told us they felt well supported by the leadership team who were visible and approachable.

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.

The areas where the provider should make improvements are:

  • Review and improve systems for monitoring patients in the secondary waiting area.

  • Review and improve the system for prescribing warfarin.

  • Review and improve the practice’s cervical screening uptake rate.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 5 April 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Huntingdon Road Surgery on 5 April 2016. Overall the practice is rated as outstanding.

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

  • Patient feedback scores from the NHS GP Survey, the Friends and Family Test (FFT) and from our own comments cards was extremely positive about the practice. Patients expressed high satisfaction levels with the service citing attentive and caring staff, continuity of GP, the quality of treatment and speedy referrals as the reasons. 174 of 176 patients who completed the FFT would recommend the practice. 88% of respondents would recommend this surgery to someone new to the area.

  • GPs held individual patient lists, encouraging good continuity of care and enabling strong relations to be built up between them and their patients.

  • There was an open and transparent approach to safety and effective systems in place to report and record significant events which enabled learning to be shared.

  • Safeguarding was given a high priority, and the practice had comprehensive, robust and effective procedures in place to protect patients.

  • Risks to patients were assessed and well managed. There was a robust programme of infection prevention and control in place which was facilitated by the infection control lead GP.

  • The practice worked closely with other health and social care teams and local community organisations such as university college nurses and the Alzheimer’s Society to deliver co-ordinated and effective care for patients.

  • The practice used a wide range of both clinical and non-clinical audits to monitor and improve outcomes for patients.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had a high level of training for their roles and were well supported in their work.

  • The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

  • High standards were promoted and owned by practice staff with evidence of good team working across all roles.

We saw one area of outstanding practice:

  • The practice had a committed and very active safeguarding lead who worked hard to ensure patients were protected. For example, in January 2016 and in addition to regular meetings with the health visitor, she had checked and updated the practice’s paediatric and domestic violence folder;hadcreated a document in relation to Gillick and Fraser guidelines and completed all pending items on the practice’s section 11 safeguarding audit. The practice’s child safeguarding learning reports had been used as a model example by other local safeguarding agencies.

The areas where the provider should make improvement are:

  • Implement a protocol for the non-collection of prescriptions and medicines by patients.

  • Read code children who do not attend hospital appointments on the practice’s clinical IT system and develop an appropriate follow up contact protocol.

  • Actively flag informal carers on the practice’s clinical IT system to make them easily known to staff.

  • Undertake regular fire evacuation simulations at the Girton branch.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice