Archived: Hawthornden Surgery

Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at Hawthornden Surgery on 5 December 2016 found breaches of regulations relating to the safe and well-led delivery of services. The overall rating for the practice was requires improvement. Specifically, we found the practice inadequate for the provision of safe services and require improvement for provision of well led service. It was good for providing effective, caring and responsive services. Consequently we rated all population groups as requires improvement. The full comprehensive report on the previous inspections can be found by selecting the ‘all reports’ link for Hawthornden Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 9 August 2017 to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made.

We found the practice had made improvements since our last inspection. At this inspection we found the practice was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Overall the practice is now rated as good. Consequently we have rated all population groups as good.

Our key findings were as follows:

• Risks to patients were assessed and well managed.
• During the previous inspection in December 2016 we found high risk issues relevant to the suitability of the premises and health and safety procedures at the branch practice. However, the practice had taken urgent steps and stopped offering appointments at the branch practice from the day after that inspection.
• The practice had carried out patients’ consultation and submitted a formal application in March 2017 to close the branch practice (Flackwell Surgery). NHS England had approved the application and the branch practice was formally closed on 20 June 2017.
• All the areas of concerns identified during the previous inspection relating to the branch practice had been resolved due to the permanent closure of the branch practice.
• Improvements had been made to maintain a safe system for medicines management including the safe storage of medicines requiring refrigeration.
• Vaccines were safely stored and the fridge temperatures were monitored daily and records maintained.
• The practice had carried out a fixed electrical installation check to ensure safety of the wiring system.
• The practice demonstrated improvement in governance arrangements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hawthornden Surgery on 5 December 2016. Overall the practice is rated as requires improvement.

Specifically, we found concerns and regulatory breaches relating to the health and safety arrangements at the branch practice more commonly known as Flackwell Surgery. We have rated the practice inadequate for the provision of safe services and requires improvement for provision of well led service. It was good for the provision of effective, caring and responsive services. The concerns which led to these ratings apply to all population groups.

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. The majority of information about safety was recorded, monitored and reviewed.There was inconsistent arrangements in how risks were assessed and managed. For example during the inspection we found risks relating to infection control procedures, fire safety arrangements, management of legionella at the branch practice and monitoring of fridge temperature checks at the main practice had not been monitored regularly.
• There was insufficient arrangements in place to deal with emergency situation at the branch practice. For example, oxygen was not available at the branch practice and a GP was lone working with no other members of staff available who could help in emergency.
• However, the practice had taken urgent steps and stopped offering the appointments at the branch practice from the day after the inspection. The practice had decided to temporarily close the branch practice and was in discussion with NHS England about the future use of the branch location.
• We found that completed clinical audit cycles were driving positive outcomes for patients.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Results from the national GP patient survey showed the patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment when compared to the local and national averages. The patients we spoke with on the day of inspection confirmed this.
• Information about services and how to complain were available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The main practice, known as Hawthornden Surgery had good facilities and was well equipped to treat patients and meet their needs.
• 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• The governance arrangements in place must ensure health and safety risks related to the branch practice are identified and mitigated to assess the suitability of the premises. This includes the carrying out of fixed electrical installation checks at both practices.
• Review and improve the systems in place to ensure an effective response to the emergency situation at the branch practice including lone working.
• Ensure access to a chaperone is available when required at the branch practice.
• Ensure effective monitoring of infection control procedures, fire safety arrangements and the management of legionella at the branch practice.

• Ensure effective monitoring of fridge temperature checks at the main practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice