The Hart Surgery

Updated 31 July 2017

The Hart Surgery has a purpose built location with good accessibility to all its consultation rooms. The premises were built in the 1970s. All the consultation rooms are located on the ground floor There is a separate treatment room waiting area and all areas are accessible to wheelchairs and mobility scooters.

The practice is contracted with NHS England to provide Personal Medical Services (PMS) to the patients registered with the practice. The practice serves 10,400 patients from Henley and the surrounding rural area. The practice demographics show that the population has a lower proportion of patients over 35 compared to the national average and a higher prevalence of patients between 40 to 65 years old and slightly higher proportion of patients over 65. The practice had a low proportion of patients from ethnic minority backgrounds. National data suggested there was minimal deprivation across the local population. 53% of patients registered have a health condition compared to the national average of 54%.

There are four male and three female GPs working at the practice. There are five nurses, including two specialist nurses, two healthcare assistants and a phlebotomist. A number of administrative staff and a practice manager support the clinical team. The Hart Surgery is a training practice for GP trainees.

There are 5.5 whole time equivalent (WTE) GPs and 3.1 WTE nurses and healthcare assistants. The nursing team included a nurse prescriber. The Hart Surgery is open between 8.00am and 6.30pm Monday to Friday. There are extended hours appointments available every Thursday morning from 7am.

Out of hours GP services were available when the practice was closed by phoning NHS 111 and this was advertised on the practice website.

The practice provides services from: The Hart Surgery, York Road, Henley On Thames, Oxfordshire RG9 2DR.

Updated 31 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Hart Surgery on 17 October 2016. The practice was rated as requires improvement for providing effective services. The overall rating for the practice was good. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for The Hart Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 3 July 2017 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 17 October 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 for providing effective services.

Our key findings were as follows:

• The practice had improved the process for monitoring patient care through monthly searches of patients, to identify reviews and interventions due. This ensured patients received effective care at the right time.

• Medicine reviews had been undertaken for 99% of all patients on a repeat prescription.

• Improved uptake of physical health checks for patients on the learning disability and mental health registers had supported patients to lead healthier lives.

• The practice had reviewed their care provision for diabetic patients through new initiatives and stakeholder engagement. Diabetes care indicators had improved, particularly in relation to blood pressure targets for patients on the diabetes register.

The practice had contracted an external stakeholder to undertake a legionella risk assessment. Whilst the assessment had been undertaken in February 2017, the practice was only in receipt of the official report in June 2017. Some high risk actions were identified which the practice had reviewed and commenced acting upon. For example, water flushing and water temperature recording commenced in July 2017.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 December 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 had appropriate training.
• Patients at risk of hospital admission were identified as a priority.
• The most recent published results showed the practice was mainly performing well compared to national averages. However, the system for monitoring medicine reviews did not ensure they were always done when required.
• All these patients were offered structured annual review to check their health and medicines needs were being met.
• Home visits were provided for diabetic reviews where patients found it difficult to attend the practices.
• 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 13 December 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 A&E attendances.
• The practice’s uptake for the cervical screening programme was 83%, which was similar to the national average of 82%.
• Immunisation rates were similar to average for all standard childhood immunisations.
• Staff explained how they treated children and young people in an age-appropriate way including recognition of their rights to access treatment.
• We saw positive examples of joint working with midwives and health visitors.
• Joint working with external organisations took place in the management of children at risk of abuse.
• The practice provided staff with guidance on female genital mutilation and how to report and respond to any instances or risks of this occurring.

Updated 13 December 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 high proportion of older people in its population.
• GPs offered personalised care to patients in care and nursing homes.
• The premises were accessible for patients with limited mobility.
• The system for monitoring medicine reviews did not ensure they were always done when required.
• A hearing loop was available for patients with poor hearing.
• Patients over 75 had a named GP to maintain continuity of care.
• Care planning was provided for patients with dementia.
• There was a dedicated TV screen for older patients.
• GPs regularly visited nursing and care homes to enable them to provide the necessary care and treatment to these patients.
• Home visits were provided for diabetic reviews where patients found it difficult to attend the practices.

Updated 13 December 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 considered and the practice had adjusted the services it offered enable continuity of care.
• Patients’ feedback on the appointment system was poor in the national GP survey, in specific areas. The practice responded by implementing changes to the system in consultation with the patient participation group (PPG).
• Extended hours appointments were available one morning a week.
• The practice was proactive in offering online services
• A full range of health promotion and screening was available that reflects the needs for this age group.
• Travel vaccinations were available.

Updated 13 December 2016

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

• Performance for mental health related indicators was 92% compared to the national average 92% and regional average of 95%.
• The proportion of patients on mental health register with an up to date care plan was 89% and 24% had a physical assessment within the current year.
• The performance overall in 2015 was poor for physical assessments and in response the practice had undertaken action to improve the coding and recall for patients with mental health problems.
• 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 advanced 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.

Updated 13 December 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 and those with a learning disability.
• The practice offered longer appointments for vulnerable patients.
• A temporary registration process was available to patients who may be in the area for a short period of time and who needed to see a GP.
• Patients with no fixed address could register at the practice if needed.
• 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.
• Joint working with external organisations took place in the management of patients at risk of abuse or harm.