The Care Quality Commission
  • Doctor
  • GP practice

Archived: Harden Surgery

Overall: Good read more about inspection ratings

Harden Road, Walsall, West Midlands, WS3 1ET (01922) 423250

Provided and run by:
Phoenix Primary Care Limited

Important: The provider of this service changed. See new profile

All Inspections

8 February 2018

During a routine inspection

We previously carried out an announced comprehensive inspection at Harden Surgery on 5 September 2016. The overall rating for the practice was Requires Improvement. This was because systems were not in place to investigate and learn from significant events, the management of safety alerts was not effective and the lack of some of the suggested emergency medicines had not been risk assessed.

We undertook an announced focused inspection on 23 May 2017 to follow up on the requirement notices. We looked at whether Harden Surgery was providing safe, effective and well led services. We continued to rate the practice as Requires Improvement overall. However we found not all of the necessary improvements had been made and we rated the practice as inadequate for providing well led services. This was because there were insufficient staff to meet the needs of patients and the governance arrangements were ineffective.

Both the full comprehensive report on the September 2016 and the focused inspection on 23 May 2017 can be found by selecting the ‘all reports’ link for Harden Surgery on our website at www.cqc.org.uk

This inspection was an announced comprehensive inspection carried out on 8 February 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 23 May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection

This practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

At this inspection we found:

  • Improvements had been made in the clinical leadership and capacity. A team of regular locum GPs worked at the practice providing continuity of care for patients. The practice management had been strengthened by the appointment of a new practice manager.
  • There was a clear leadership structure and staff felt supported by management. Staff told us they were now able to raise concerns, were encouraged to do so and had confidence that these would be addressed.
  • The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learnt from them and improved their processes. Improvements had been made and information and learning from significant events was discussed at clinical and practice meetings.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • The practice worked closely with other health and social care professionals involved in patient’s care. Regular meetings had been re-established with the community nursing teams and palliative care teams to discuss the care of patients who were frail / vulnerable or who were receiving end of life care.
  • The practice had carried out clinical audits to review the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. The audits seen demonstrated quality improvements.
  • Patients commented that they were treated with compassion, kindness, dignity and respect.
  • We found that the scores for GPs and nurses in the GP Patient Survey published July 2017 were comparable to the local averages. A number of the satisfaction scores relating to access were lower than the local averages. The practice had reviewed these scores and taken action to address them. For example a new telephone system had been installed and the number of GP appointments had increased.
  • Information about services and how to complain was available.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

However, there were also areas of practice where the provider should make improvements.

  • Continue to develop the carers’ register.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

23 May 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harden Surgery on 5 September 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Harden Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 23 May 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 5 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice continues to be rated as requires improvement.

Our key findings were as follows:

  • Since the previous inspection systems for reporting and recording significant events had generally improved. Records showed that the practice had responded to significant events; however, evidence of shared learning with the wider team was limited.
  • Previously systems for receiving and acting on alerts from the Medical and Healthcare products Regulatory Agency (MHRA) were not effective. At this inspection recording and distribution of alerts had improved. However, the practice did not operate an effective process to ensure appropriate actions were carried out.
  • At our September 2016 inspection, we found that risk had not been formally assessed in the absence of some emergency medicines and a record of fire safety checks was not maintained. During this inspection we found the arrangements to respond to medical emergencies and recording of fire safety checks had been strengthened.
  • When we carried out our previous inspection, staff we spoke with felt staffing levels was insufficient. During this inspection, we were told that there had been some improvement since the recruitment of extra non-clinical staff; however, we saw that some clinics had not been uploaded onto the practice system as GP cover had not been secured.
  • Quality Outcomes Framework (QOF) data showed areas where the practice performance had improved since the previous inspection.
  • The uptake of national screening such as breast and bowel cancer had increased since the September 2016 inspection.
  • Since our previous inspection governance arrangements had improved in some areas. For example, processes for sharing evidence based guidance and outcomes from GP updates had improved. However, at this inspection, the practice was unable to evidence where they had carried out clinical audits to monitor quality improvements or demonstrate effective use of data to drive improvements. Arrangements to keep non-clinical staff informed about changes within the practice had not been established.

At our previous inspection on 5 September 2016, we rated the practice as requires improvement for providing safe services as the system for managing safety alerts, incidents and staffing levels needed improving . At this inspection we found some improvements; however, sharing learning following incidents, oversight of safety alerts and staffing levels required further improvement. Consequently, the practice is still rated as requires improvement for providing safe services and as a result of this inspection the practice is rated inadequate for providing well-led services.

Importantly, the provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

  • Ensure clinical performance initiatives such as clinical audits are carried out to monitor quality improvements.

  • Establish effective communication systems to ensure that reviews about the quality and safety of the service and any actions required following reviews are shared throughout the practice.

  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment.

In addition the provider should:

  • Continue to consider ways of encouraging the uptake of national screening programmes such as bowel and breast cancer.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

5 September 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

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

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, there were variations in the recording of investigations and outcomes.

  • Most risks to patients were assessed and well managed. However, a risk assessment had not taken place to mitigate the absence of some recommended emergency medicines in the event of a medical emergency and the practice did not have an effective process for monitoring the completion of fire safety checks and fire drills.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • The system in place for sharing medicines alerts and learning for GP update days was on an informal basis and we found that the practice did not establish an effective process.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. However, the practice did not operate an effective system for identifying carers.
  • Information about services and how to complain was available and easy to understand. Evidence of improvements to the quality of care as a result of complaints and concerns was limited.
  • 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 practice had good facilities and was well equipped to treat patients and meet their needs.

  • There was a clear leadership structure and most staff felt supported by management. Staff felt there was little communication from senior management regarding actions taken or outcomes as a result of feedback and concerns raised.

  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

  • Establish an effective system to ensure clinical incidents are thoroughly investigated and monitored to ensure appropriate actions are taken to remedy the situation, prevent future occurrence and implement improvements as a result.

  • Ensure that risk assessments for the absence of some emergency medicines are carried out to mitigate risks associated with anticipated emergency situations.

  • Implement a formal system for managing medicines alerts from the Medicines and Healthcare products Regulatory Agency (MHRA) and ensure the system includes processes for sharing with all clinicians at the practice.

The areas where the provider should make improvements are:

  • Review systems in place for monitoring the completion of fire safety checks and fire drills.

  • Ensure that feedback from staff is appropriately considered and outcomes communicated where appropriate.

  • Continue encouraging the uptake of national screening programmes such as bowel and breast cancer.

  • Review the process for identifying carers to ensure patients with a caring responsibility are identified in order to provide appropriate care, support and guidance.

  • Improve the number of care plans completed for patients with learning disabilities and vulnerable groups.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice