Honeywall Medical Practice

We carried out an announced comprehensive at Honeywall Medical Practice on 6 December 2023. Overall, the practice is rated as good.

Safe - requires improvement

Effective - good

Caring - outstanding

Responsive - outstanding

Well-led - good

During our previous inspection on 26 January 2016, the practice was rated outstanding for the key questions effective and caring, and rated good in safe, responsive and well led, with a rating of outstanding overall. We rated the practice as outstanding at the last inspection in providing an effective and caring service because:

• Patients’ care and treatment was well managed and the number of patients who had been admitted to hospital in an emergency was significantly lower than local levels.
• The practice named GPs operated a ‘concern’ list of patients with complex needs. The list was known by and shared by each GP. This was to enable the sharing of concerns regarding patients that were not coping well medically, socially or emotionally.

At this inspection, we found the areas previously regarded as outstanding practice were now embedded in many practices. While the provider had maintained this good practice, the threshold to achieve an outstanding rating in effective had not been reached and we rated the effective key question as good. However, the practice remained outstanding in providing a caring service and we rated providing a responsive service, as outstanding.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Honeywall Medical practice on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection in line with our inspection priorities.

The focus of inspection included:

• All 5 key questions
• We followed up on the ‘shoulds’ identified in the previous inspection

How we carried out the inspection/review

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A site visit.
• Provision of information from stakeholders such as Healthwatch and a care home.
• Staff questionnaires.

Our findings

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 and
• information from the provider, patients, the public and other organisations.

We rated the practice as outstanding for providing caring services because:

• Feedback from patients who used the service, those who were close to them, and stakeholders was continually positive about the way staff treated patients.
• Patients were respected and valued as individuals and were empowered as partners in their care, practically and emotionally, by an exceptional and distinctive small practice team.
• Patients thought that staff went the extra mile, and their care and support exceeded their expectations.
• Feedback from patients was consistently positive including 24 patients who gave feedback on their care direct to the Care Quality Commission.
• The practice demonstrated a truly patient-centred culture and staff were committed to delivering excellent care to meet the needs of individuals. Their vision and values being the practice exists for patients.
• The practice adopted a holistic approach to caring by addressing all the needs of the patient, including their physical, mental, and emotional health, while taking social factors into consideration.
• The practice had achieved outstanding results in the national GP Patient survey and had maintained these high standards for several years and remained higher than local and national averages. The survey results in 2023 found 100% of patients found the receptionists at the practice helpful.
• We found numerous examples of how the practice had gone to significant efforts to support vulnerable individuals to access health and social care, and how they had worked pro-actively with other organisations to support patients.
• The whole practice approach was that patients came first, every contact counted, and a caring ethos was fostered and developed in staff with the motivating force being that the practice existed for patients.

We rated the practice as outstanding for providing responsive services because:

• We found that patients individual needs and preferences were central to the delivery of services.
• The practice had achieved outstanding results in the national GP Patient survey and had maintained these high scores for several years.
• Services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care.
• There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.
• Patients could access care and treatment in a timely way.
• The practice embraced social prescribing for the community to ensure patients received timely intervention when they needed it most, signposted them to services that could help them and ensured support was offered locally so the patient population could easily attend appointments.

We have rated this practice as requires improvement for providing a safe service because:

• There were some gaps seen in staff recruitment records which the practice was aware of and was in the process of actioning.
• Some patients prescribed an oral non-steroidal anti-inflammatory medicine over 65 years, or an antiplatelet over 75 years, had not been prescribed a proton pump inhibitor (PPI), which can reduce the risk of gastrointestinal bleeds.
• The records of some female patients of childbearing age prescribed medicines known or suspected to have the potential to increase the risk of birth defects and development disorders did not have a documented account that they had been advised of the risks.

We have rated this practice as good for providing an effective and well led service because:

• Patients received effective care and treatment that met their needs.
• The way the practice was led and managed, promoted the delivery of high-quality, person-centre care.
• There were high levels of staff satisfaction across all staff groups. Staff were proud of the practice as a place of work and spoke highly of the culture.
• Staff at all levels were actively encouraged to speak up and raise concerns, and policies and procedures positively supported this process. There was evidence of consistently high levels of constructive staff engagement.
• Staff felt valued and supported to develop personally and professionally.
• There was a strong practice commitment towards equality and inclusion across their patient population and the workforce. Quality and integrity were a high priority resulting in a caring and responsive culture.

We found a breach of regulation. The provider must:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The provider should:

• Improve the medicine reviews and recall systems for patients prescribed an oral non-steroidal anti-inflammatory medicine over the age of 65 years, or an antiplatelet over the age of 75 years without being prescribed a proton pump inhibitor (PPI), which can reduce the risk of gastrointestinal bleeds.
• Take action to recall female patients of childbearing age prescribed medicines known or suspected to have the potential to increase the risk of birth defects and development disorders and document when they have been advised of risks.
• Take steps to document the risk assessments on emergency medicines not held by the practice.
• Take action to develop a whole practice approach to the learning from significant events and trend analysis.
• Take action to implement a patient participation group.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care