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Review carried out on 8 February 2020

During an annual regulatory review

We reviewed the information available to us about GP Direct on 8 February 2020. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 30 September 2019

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at GP Direct on 9 August 2018. The overall rating for the practice was good with a rating of requires improvement in the Safe key question The full comprehensive reports on the August 2018 inspection can be found by selecting the ‘all reports’ link for GP Direct on our website at cqc.org.uk.

At the last inspection in August 2018, we rated the practice as requires improvement for providing safe services because:

  • There was no clear system to monitor the stock levels and expiration of vaccines at the practice.
  • There was no clear system to monitor blank prescription forms.

We also found areas where the provider should make improvements:

  • Take action to ensure all the actions arising from risk assessments are recorded.
  • Take action to carry out NHS health checks for patients aged 40-74.
  • Improve the recording of complaint responses to ensure the ombudsman details are always included.

This inspection was an announced focused follow up inspection carried out on 30 September 2019, to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 9 August 2018. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

Overall the practice is now rated as Good for providing safe services and continues to be rated Good overall.

Our key findings were as follows:

  • The practice had a clear system to monitor the stock levels and expiration of vaccines at the practice.
  • The practice had a clear system to monitor blank prescriptions.
  • Actions arising from fire, health and safety risk assessments were now completed and signed.
  • The practice had carried out 88 NHS health checks since the last inspection; however, this was affected by staffing changes which led to fewer health checks completed.
  • The practice ensured ombudsman details were included in all complaints.

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

  • Continue to monitor and improve health checks for patients aged 40-74.

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

Inspection carried out on 9 August 2018

During a routine inspection

This practice is rated as Good overall. (Previous rating: March 2017 – Good)

We carried out an announced comprehensive inspection at GP Direct on1 June 2016. The overall rating for the practice was good with a rating of requires improvement in the Safe domain. The full comprehensive reports on the June 2016 can be found by selecting the ‘all reports’ link for GP Direct on our website at cqc.org.uk.

This inspection was an announced follow up comprehensive inspection carried out on 9 August 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 1 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Overall the practice is now rated as Good.

The key questions at this inspection 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

At this inspection we found:

  • Some risks to patients were assessed and well managed, except for those relating to medicines management, health and safety risk assessments.
  • When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines.
  • The practice had modern, purpose built facilities which had recently undergone extensive improvement and refurbishment. The new premises were well equipped to treat patients and meet their needs.
  • The practices GP patient survey results were above local and national averages for questions relating to kindness, respect and compassion.

  • Patients found the appointment system easy to use and reported that they could access care when they needed it.
  • The practice was very engaged with technological developments which aimed to improve the patient journey, which they could share with other practices.
  • There was a strong focus on continuous learning and development at all levels of the organisation. The practice used innovative and proactive methods to assure effective communications across the organisation.
  • Staff at all levels of the organisation had access to a suite of bespoke training materials to cover the scope of their work and meet their learning needs.
  • The practice used innovative and proactive methods to improve patient outcomes and worked with other local and national healthcare providers to share best practice. This included arranged events such as a health and fitness day, the walking group and patient research.
  • The practice had strong visible and clinical and non-clinical managerial leadership arrangements.

We saw some areas of outstanding practice:

  • The lead GP set up a Sunday morning walking group in the local park in July 2016, which encouraged patients to exercise. The walking group was open to all Harrow residents, was advertised through different channels such as the journal and website and featured in the local paper. The walking group had an attendance rate of approximately 30 patients and was usually followed by a short medical related talk from the lead GP or local hospital consultants. A survey was carried out in August 2018 on 24 patients who attended the walking group and results showed that 100% of the patients felt it was important and 84% reported some or significant benefits from undertaking the walk. 100% of patients would recommend the walking group to family and friends.
  • The practice had an agreement to carry out intrauterine device (IUD) fittings for their local family planning clinic. They would provide a spill over service to offer the clinic support to meet their turnaround times for IUD fittings. This ensured that ensured patients were seen in a timely manner. The service had run successfully since its inception in May 2018, with around 60 patients being seen at the practice. They created efficient systems such as a bypass number, to allow for an easy booking process between the family planning centre and there was co-ordinated use of the Emis Web to allow for registration of patients and text message reminders in advance of their appointment. 100% of the 24 patients who completed the Friends and Family test said they would recommend this service to friends and family.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way for patients.

The areas where the provider should make improvements are:

  • Take action to ensure all the actions arising from risk assessments are recorded.
  • Take action to carry out NHS health checks for patients aged 40-74.
  • Improve the recording of complaint responses to ensure the ombudsman details are always included.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Inspection carried out on 1 June 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at GP Direct on 1 June 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 an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and managed with the exception of infection control, medicines management, mandatory staff training and risk management which were not effective.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Information about services and practice news was made available through their tri-annual publication of the GP Direct journal.
  • The practice was very engaged with technological developments which aimed to improve the patient journey, which they were able to share with other practices.
  • Patients said they were able to get appointments when they needed them and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice were recognised in two local newspapers for their work in helping patients to stop smoking.
  • 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.
  • There was a buddy system in place for new reception staff to facilitate learning and integration into the team.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice including:

  • The practice co-organised a health and fitness open day in September 2015 to promote healthy living. Amongst other activities, the practice provided basic life support and disease prevention sessions. Following positive feedback from participants, the event is now happening annually.

  • The newly appointed nursing case manager had provided care to 288 housebound patients and as a result, 44 of these patients had avoided hospital admission. She was featured in an edition of a national nursing publication and a housebound patient survey completed by seven patients showed 90% of these patients felt the input from the nursing case manager had helped them stay better and healthier at home.

  • The Time to Learn sessions which took place every week to continuously improve how the practice delivered services to the patients. This included presentations from the clinical and reception staff and covered such topics as medical reports, clinical procedures and health checks.

The areas where the provider must make improvement are:

  • Ensure effective medicines management processes are in place and operated effectively and this includes emergency medicines.
  • Take action to ensure premises and equipment are kept clean, properly maintained and comply with the guidance from legislation about the prevention and control of infections. Ensure annual infection control audits are carried out for all sites and they are completed accurately.
  • Ensure the procedures in place for monitoring and managing health and safety risks are effective, including adequate fire safety arrangements are in place at all sites.
  • Ensure mandatory staff training for all staff is up to date.

In addition the provider should:

  • Review the national GP patient survey scores with the aim of improving patient satisfaction scores on access to appointments.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice