Hook Surgery

Updated 13 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Hook Surgery on 8 June 2016. Breaches of legal requirements were found. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breaches of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the comprehensive inspection we found that the practice had failed to do all that was reasonably practicable to ensure that sufficient safeguards were in place when prescribing medicines, this included the bulk prescribing of high-risk medicines such as Warfarin, and the lack of formal guidelines for prescribing by the nurse practitioner; that they did not have processes in place to ensure that the temperature of the vaccines refrigerator was monitored on a daily basis and had failed to keep comprehensive records of action taken when the temperature had gone outside of the optimum range; that they did not do all that as reasonably practicable to ensure that patients who failed to collect prescriptions were followed-up; and that they did not have sufficiently robust processes in place to ensure that there was clinical oversight of all hospital correspondence received.

We also found areas where the practice should make improvements. We found that the practice had been recording significant events, but that their records did not always contain sufficient detail; the practice provided training to its staff but processes in place to identify when refresher training was due had not been maintained; at the time of the initial inspection, the practice's Patient Participation Group had been recently restructured and the new group was in the process of becoming fully established; the practice had identified 13 carers, which represented less than 1% of their patient population.

We undertook this focussed inspection on 9 December 2016 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Hook Surgery on our website at www.cqc.org.uk.

Overall the practice was rated as good following the comprehensive inspection. They were rated as requires improvement for providing safe services. Following the focussed inspection we found the practice to be good for providing safe services.

Our key findings across all the areas we inspected

were as follows:

• There was an effective system in place of reporting and recording significant events.
• The practice’s arrangements for prescribing medicines was in line with guidelines and up to date policies were in place.
• Prescription sheets and pads were stored safely and records were kept of stocks held.
• The practice recorded the temperature of their medicines fridges daily; however, their temperature log did not record full details of action taken when fridge temperatures went out of the optimum range.
• All clinical letters were reviewed by GPs.
• All staff were up to date with mandatory training sessions and processes were in place to flag when training was due.
• The patient participation group continued to meet regularly.
• The practice had identified 13 carers at the time of the initial inspection; however, they felt that this was not a true representation of their carers register and that there had been an error in their data collection. At the time of the follow-up inspection they re-interrogated their patient records system, and we saw evidence that they had 115 carers on their register, which represented 2% of their patient list.

The practice should take action to address the following area:

• They should ensure that full details are recorded of action taken when medicines fridge temperatures go out of the optimum range.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 25 October 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The nurse practitioner held an advanced qualification in diabetes care, and was the practice’s diabetes lead.
• Performance for diabetes related indicators were comparable to local and national averages. Overall the practice achieved 99% of the total QOF points available, compared with an average of 96% locally and 89% nationally. The proportion of diabetic patients who had a record of well controlled blood pressure in the preceding 12 months was 88%, which was above the Clinical Commissioning Group (CCG) average of 80% and national average of 78%; and the proportion of diabetic patients with well controlled blood glucose level in the preceding 12 months was 78%, compared to a CCG average of 80% and national average of 78%. We saw evidence that these patients received the necessary checks and interventions in order for them to keep healthy, such as foot checks and flu immunisations.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 25 October 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of Accident and Emergency (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Staff at the practice told us that the practice had a policy of providing all children under 16 years of age with a same day appointment; however, some patients we spoke to were not aware of this policy.
• Cervical screening had been carried-out for 84% of women registered at the practice aged 25-64, which was comparable to the Clinical Commissioning Group (CCG) average of 82% and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors. 

Updated 25 October 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• They were working with the local service which offered advice, support and socialising opportunities to elderly people, and were in the process of arranging for the practice to provide funding to support their patients to access Staywell’s services, for example, by paying the transport costs for those patients who could not afford them.

Updated 25 October 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. Extended hours appointments were available with both GPs and nurses.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice provided a full range of family planning services, including contraceptive implants and coil fitting.
• The practice sent appointment reminders and health promotion information by text message.

Updated 25 October 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice had 33 patients diagnosed with dementia and 97% had had their care reviewed in a face to face meeting in the last 12 months, which was better than the Clinical Commissioning Group (CCG) average of 83% and national average of 84%.
• The practice had 42 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 97% of these patients, compared to a CCG average of 92% and national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia. They provided a service to residents of a nearby care home for people with dementia and were working closely with them to encourage a co-ordinated approach to care, involving community nursing and palliative care teams.

Updated 25 October 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers, carers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.