Hatfield Road Surgery

Updated 3 May 2018

Hatfield Road Surgery provides a range of primary medical services from its premises at 2 The Parade, Ellis House, Charrington Place, St Albans, Hertfordshire, AL1 3FY. The practice has a registered manager in place. (A registered manager is an individual registered with CQC to manage the regulated activities provided).

The practice serves a population of approximately 3,887. National data indicates St Albans is less deprived compared to England as a whole. However, the practice informed us there are areas of deprivation in its locality. The practice population is ethnically diverse with large South Asian (particularly Bangladeshi and Pakistani) communities. The practice serves an above average population of those aged from 30 to 44 years. There is a lower than average population of those aged 65 years and over.

The clinical team includes two male GP partners, one female salaried GP and two regular locum nurses. The team is supported by a practice manager and four other secretarial, administration and reception staff. The practice provides services under a General Medical Services (GMS) contract (a nationally agreed contract with NHS England).

At Hatfield Road Surgery the phone lines open from 8am and the practice is fully open (phones and doors) from 8.45am to 6.30pm Monday to Friday. There is extended opening every Thursday from 6.30pm to 8.30pm for GP pre-bookable appointments. Appointments are available from 9am to 11.30am and 4pm to 6.30pm daily, with slight variations depending on the doctor and the nature of the appointment.

An out of hours service for when the practice is closed is provided by Herts Urgent Care.

Updated 3 May 2018

We carried out an announced comprehensive inspection at Hatfield Road Surgery on 19 September 2017. Overall the practice was rated as good. However, we identified breaches of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided well-led services. Consequently the practice was rated as requires improvement for providing well-led services. The full comprehensive report on the September 2017 inspection can be found by selecting the ‘all reports’ link for Hatfield Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 April 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches of regulation that we identified in our previous inspection on 19 September 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

On this focused inspection we found that the practice had made improvements since our previous inspection and were now meeting the regulation that had previously been breached.

The practice is now rated as good for providing well-led services.

Our key finding was as follows:

• There were effective governance arrangements in place to ensure complaints were managed in accordance with the practice’s policy and procedure and the absence of a defibrillator was appropriately risk assessed.

Additionally where we previously told the practice they should make improvements our key findings were as follows:

• The practice kept a record of fire drills. We saw that the fire drill completed in January 2018 had been documented. This included a record of how many staff and patients were involved, the time taken by them to evacuate the building and that all employees and visitors were accounted for during a roll call among other things. The record showed that no further action was required as a result of the drill as all staff had correctly followed procedure and the alarm system worked as it should.
• Following our inspection in September 2017 the practice had reviewed and updated its business continuity plan. We saw the plan now contained details of how the practice would respond to any loss of premises, power, telephones and medical records among other things. This included an arrangement for the temporary use of space at another local practice in an emergency situation. We saw the plan contained up-to-date contact details for all staff at the practice along with those of service providers such as utility companies. From our conversations with staff we found that both GP partners and the practice manager kept a copy of the plan off-site should the practice be inaccessible in an emergency situation.
• The practice discussed the below average uptake among its patient population for some nationally run and managed cancer screening programmes. The staff we spoke with demonstrated an understanding of the cultural sensibilities to such programmes displayed by some of its patient population. There was evidence to suggest the practice responded to those sensibilities and encouraged its relevant patients to engage with them and attend for screening. For example, between them the GPs at the practice could offer consultations in languages other than English including Bengali, Hindi and Urdu. Many of the practice’s patients with English as a second language could be informed about and encouraged to attend the cancer screening programmes by the GPs in their first language during consultations. We saw the practice acted on information it received from NHS England about patients who had not responded to their invitations to participate in the bowel cancer screening programme. Between 1 April 2017 and 31 March 2018 the practice wrote to 98 such patients encouraging them to participate. We noted the letters were always sent in English but at the time of our inspection the practice was considering sending translated versions of the letter for the relevant patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 October 2017

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

• The GPs supported by the nurses had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was similar to the CCG and national averages. For example, the practice achieved 96% with 10% exception reporting compared to the CCG average of 90% with 11% exception reporting and the national average of 90% with 12% exception reporting.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All patients with a long term condition had a named GP and there was a system to recall patients for 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 23 October 2017

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

• There were systems 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.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable with the CCG average of 82% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• The practice facilities were suitable for children and young people. There was a baby changing room that also provided privacy for breastfeeding mothers.

Updated 23 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. Annual health checks were offered to all patients over 75 years of age.

Updated 23 October 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.
• The practice sent SMS text message reminders of appointments and telephone consultations were available with the GPs.
• The practice was proactive in offering online services such as appointment booking and repeat prescription requests.
• The practice promoted a full range of health promotion and screening that reflected the needs for this age group.
• 63% of females, aged 50-70 years, were screened for breast cancer in last 36 months compared to the CCG average of 72% and the national average of 73%.
• 49% of patients, aged 60-69 years, were screened for bowel cancer in last 30 months compared to the CCG average of 58% and the national average of 58%.

Updated 23 October 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• Performance for mental health related indicators was similar to the CCG and national averages. For example, the practice achieved 100% with 4% exception reporting compared to the CCG average of 95% with 9% exception reporting and the national average of 93% with 11% exception reporting.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 23 October 2017

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.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• An annual health check was offered to patients identified as having a learning disability. There were 34 patients on the register and all of these had received a health check in the previous 12 months.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.
• The practice had identified 64 patients as carers which equated to approximately 2% of the practice list. There was a carers champion and a carers noticeboard in the patient waiting area with written information available to direct carers to the various avenues of support available to them. The practice had achieved gold level of the Herts Valleys Local Incentive Scheme by completing a survey of their carers to demonstrate satisfaction and an awareness of the carers champion and support available to them.