The Care Quality Commission
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  • GP practice

The Hall Practice

Overall: Outstanding read more about inspection ratings

Hampden Road, Chalfont St. Peter, Gerrards Cross, Buckinghamshire, SL9 9SA (01753) 887311

Provided and run by:
The Hall 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 Hall 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 Hall Practice, you can give feedback on this service.

26 February 2020

During an inspection looking at part of the service

We carried out an announced focused inspection at The Hall Practice, a GP practice in Chalfont St. Peter, South Buckinghamshire on 26 February 2020 as part of our inspection programme.

We carried out an inspection of this service following our annual review of the information available to us. This inspection looked at the following key questions:

  • Are services effective?
  • Are services well-led?

Following assurance received from our review of information we carried forward the ratings for the following key questions from the previous inspection in April 2015:

  • Are services safe?
  • Are services caring?
  • Are services 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
  • Information from the provider, patients, the public and other organisations.

Following this inspection, the overall rating remains the same and we have rated this practice as Outstanding overall. The practice continues to be rated as Outstanding for providing effective services and is now rated Outstanding for providing well-led services. Two population groups: older people and people whose circumstances may make them vulnerable are also rated Outstanding whilst the remaining four population groups (people with long term conditions, families, children and young people; working age people (including those recently retired and students) and people experiencing poor mental health (including dementia) have been rated as Good.

We rated the practice as Outstanding for providing effective services because:

  • Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools. This included the adaption of tools to ensure practice staff shared standardised, concise and focused information.
  • Historically outcomes for patients who use services were consistently very good. We saw evidence of data irregularities for the 2018/19 period and saw the practice was proactive and sort a resolution to address these irregularities. Unverified data collected during the inspection indicated timely and correct clinical interventions had taken place.
  • The practice worked in partnership with other services and organisations and kept up to date with new research and development to make sure staff are trained to follow best practice and patients received effective care. For example, an ongoing quality improvement programme to improve outcomes for a cohort of complex care patients who accessed GP services.
  • There was a proactive support and appraisal system for staff, which recognises that continuing development of skills, competence and knowledge is integral to ensuring high-quality care and support.
  • Staff, teams and services were committed to working collaboratively and have found innovative and efficient ways to deliver more joined-up care to people who use services.

We rated the practice as Outstanding for providing well-led services because:

  • The practice had a clear vision, strategy and supporting objectives which were stretching, challenging and innovative, whilst remaining achievable. The core vision of the practice was now underpinned by four values.
  • We found there was good staff morale in the practice, with high levels of team spirit and motivation. There was a strong learning culture evident in the practice. This came across clearly through discussions with staff members and in the approach to adopting and championing new initiatives. Already an accredited training practice, the practice had signed up to a project to introduce and support 6th formers (aged 16-18) from under represented backgrounds into general practice.
  • There was a reformed, yet clear leadership structure and staff felt supported by management. Staff commented on recent positive changes within the management team, the strong sense of team across all teams and the focus to achieve the practice objectives and deliver an outstanding service to people accessing services at the practice.

We saw several areas of outstanding practice:

  • The practice had innovation and quality improvement at its heart and was continually seeking new ways to develop new and more effective pathways for patient care. This included the use of known quality improvement models and methodologies to improve patient outcomes. All staff we spoke with and received feedback from commented on the culture to learn, improve and how they were supported to lead and deliver change. This included feedback from staff members currently at the practice in a learning and developmental role, such as the GP registrars.
  • The practice had recently been recognised for its endeavour in becoming a more environmentally friendly practice and was awarded a bronze award as part of the Green Impact for Health project. The scheme was designed to improve the environmental performance of the practice while saving money and ensuring that the provision of services offer the greatest benefit to society as a whole.

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

  • Continue to improve uptake for cervical screening to ensure the practice meets the national target of 80%.

Details of our findings and the evidence supporting the change in rating are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

2 April 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Hall Practice, Hampden Road, Chalfont St. Peter, Gerrards Cross, Buckinghamshire, SL9 9SA. The practice had been inspected in 2013. However, this was the first inspection under the new CQC comprehensive inspection approach and was undertaken to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Overall the practice is rated as outstanding. It delivers outstanding effective and caring services and services to the population groups of patients with long term conditions and those in circumstances that may make them vulnerable are also outstanding. The practice is rated as good delivery of safe and responsive services and for being well led.

Our key findings were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them. Patient feedback on the care they received was consistently positive and patients commented that they were partners in making decisions about their care and treatment.
  • The practice had adequate facilities and was well equipped to treat patients and meet their needs. The practice recognised they needed additional space in which to treat patients and plans were in place to move to larger premises.
  • Information about how to complain was available and easy to understand.
  • The appointments system was flexible and patients reported no problems in accessing appointments with their named GP. Patients and staff were positive about the benefits of a named GP giving continuity of care.
  • The practice was clean and tidy and there were robust systems in place to reduce the risk of cross infection.

We saw areas of outstanding practice including:

  • A member of the practice staff carried out the role of carers coordinator. They made annual contact with every carer, personally, on the practice register to ensure they were receiving the care and support they required and updated the carers register based on their contact.
  • The practice had completed over 300 coordinated care records for patients with most complex health needs. These had been securely transferred to the out of hours service to support patient care when the practice was closed.
  • The practice manager met all newly registered patients and during this meeting they advised patients how to use the appointments system. We saw that 47% of patients were signed up to use the online appointment booking facility and many did so.
  • One of the GPs had special interest and expertise in dermatology. There were fewer referrals to hospital dermatology departments compared to other practices because this GP was able to provide appropriate care and treatment at the practice for many dermatological conditions patients presented with.
  • Five GPs held additional qualifications in obstetrics and gynaecology. This meant they could support the care and treatment of women presenting with gynaecological conditions and the referral rate to hospital gynaecology departments was lower than other practices.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During a check to make sure that the improvements required had been made

When we visited the practice on 28 November 2013, we found staff did not have access to appropriate safeguarding training and guidance. There was no evidence that disclosure and barring service checks had been completed. Risk assessments had not been completed regarding staff acting as chaperones. We found the practice did not monitor staff training that had taken place and when refresher training was required. The practice did not have effective systems in place to monitor and review the practice policies and procedures. We set a compliance action in respect of this. We received an action plan which set out what actions were to be taken, to achieve compliance.

Since our last visit the practice made contact with us and supplied documentation to show improvements had been made. The practice had updated their safeguarding policies and procedures for both children and adults and these were available to all staff electronically.

The practice confirmed to us all new staff members were required to complete a Disclosure and Barring Service (DBS) check. For all existing staff an ad-hoc check was planned. We saw evidence the practice had effective systems in place to ensure appropriate checks were completed.

We were able to establish the practice now had effective systems in place to monitor staff training and policies and procedures.

28 November 2013

During a routine inspection

We spoke with ten patients who used the service. Patients told us they felt able to openly discuss the reason for their visit with the GP or nurse and they were given sufficient information on any treatment required. Some comments included 'I always feel involved...appropriate leaflets are given out to explain any new drugs given to me' and 'Very inclusive approach, backed up with literature.'

The patients we spoke with were complimentary about staff and told us the practice met their needs. One patient told us 'The GP spends time reinforcing the information and I never felt hurried." Another patient described the practice as 'Brilliant.' Most patients told us they could get an appointment when needed.

The patients we spoke with told us they felt comfortable, safe and were able to discuss issues with staff. However, patients who use the service were not fully protected from the risk of abuse, because the provider had not taken all reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found patients were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We found the provider had some systems to regularly assess and monitor the quality of the service that patient's received. However, the practice did not monitor the staff training that had taken place and when refresher training was required. The practice did not have effective systems in place to monitor and review the practice policies and procedures.