Harvey Group Practice

Updated 11 September 2017

Harvey Group Practice provides a range of primary medical services from its premises at Harvey House Surgery, 13-15 Russell Avenue, St Albans, Hertfordshire, AL3 5HB and Jersey Farm Surgery, 2 St Brelades Place, St Albans, Hertfordshire, AL4 9RG. The practice has two registered managers in place. (A registered manager is an individual registered with CQC to manage the regulated activities provided).

The practice serves a population of approximately 13,240 and is a teaching and training practice. The area served is less deprived compared to England as a whole. The practice population is mostly white British. The practice serves an above average population of those aged from 0 to 14 years and 35 to 54 years. There is a lower than average population of those aged from 15 to 29 years and 60 to 74 years.

The clinical team includes four male and three female GP partners, three female salaried GPs, three trainee GPs, four practice nurses and two healthcare assistants. The team is supported by a practice manager and 20 other managerial, secretarial, administration and reception staff. The practice provides services under a General Medical Services (GMS) contract (a nationally agreed contract with NHS England).

Harvey House Surgery is fully open (phones and doors) from 8am to 6.30pm Monday to Friday. There is no lunchtime closure at Harvey House Surgery. There is extended opening every Saturday from 8.40am to midday for GP and nurse pre-bookable appointments. Appointments are available from 9am to 12.30pm and 4pm to 6pm daily and additionally from 2.30pm to 4.30pm on some days, with slight variations depending on the doctor and the nature of the appointment.

Jersey Farm Surgery is fully open (phones and doors) from 8am to midday and 3.30pm to 6pm Monday to Friday except Wednesdays when the afternoon opening is from 2.15pm to 4.45pm. When Jersey Farm Surgery is closed the phones are answered at Harvey House Surgery. Appointments are available from 9am to 12.30pm and 4pm to 6pm daily except Wednesdays when the afternoon times change from 2.30pm to 4.30pm, 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 11 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harvey Group Practice on 30 November 2016. The overall rating for the practice was good. However, we identified breaches of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided safe services. Consequently the practice was rated as requires improvement for providing safe services. The full comprehensive report from the 30 November 2016 inspection can be found by selecting the ‘all reports’ link for Harvey Group Practice on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to;

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014

- Safe care and treatment.

The areas identified as requiring improvement during our inspection in November 2016 were as follows:

• Ensure an appropriate system is in place for the safe use and management of medicines including medical consumables and controlled drugs prescriptions.
• Ensure that sufficient fire safety systems and processes are in place and adhered to.

In addition, we told the provider they should:

• Take steps to ensure that hot water temperatures at the practice are kept within the required levels.
• Ensure that all staff employed are supported by receiving appropriate supervision and appraisal and are completing the essential training relevant to their roles, including safeguarding, infection prevention and control and basic life support training.
• Ensure that all GPs have sufficient knowledge of the Deprivation of Liberty Safeguards (DoLS) and that a DoLS register is in place.
• Continue to identify and support carers in its patient population.
• Continue to take steps to ensure that in future National GP Patient Surveys the practice’s areas of below local and national average performance are monitored and improved, including access to appointments.

We carried out an announced focused inspection on 15 August 2017 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. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key finding on this focused inspection was 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 safe services.

On this inspection we found:

• A sufficient process was in place and adhered to for recording the collection of controlled drugs prescriptions.
• Staff completed appropriate checks on the stock and expiry dates of all medicines and medical consumables.
• Sufficient fire safety systems and processes were in place and adhered to.

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

• All staff had completed adult and child safeguarding, infection prevention and control and basic life support training within the required timescales.
• Some cold and hot water temperatures recorded at both surgeries were outside the required levels. Following investigation of the causes of this, the practice was considering its options as to how best to proceed to resolve the issue. In the meantime, the practice had measures in place to assist in reducing any risks to staff and patients.
• A programme was in place to ensure all staff received an appraisal on an annual basis and this was on schedule. We found that all non-clinical and nursing staff employed for more than a year, including those previously overdue their annual appraisals, had been offered or received a fully documented appraisal by December 2016.

• We saw that following our November 2016 inspection the practice took immediate action and introduced a Deprivation of Liberty Safeguards (DoLS) policy and process. (The Deprivation of Liberty Safeguards is a process used to lawfully deprive a person in a care home or hospital of their liberty in certain circumstances). A DoLS register was in place and this included the practice’s computer system alerting staff if a patient was subject to a DoLS process. The GPs we spoke with demonstrated a comprehensive understanding of the Deprivation of Liberty Safeguards including changes made to the legal requirements in April 2017.

• The practice had been proactive in increasing the amount of carers identified in its patient population and those offered a health review. We saw that a process was in place for all identified carers to receive a written invitation for an annual health review and the flu vaccination. We saw that part of the full staff meeting on 24 May 2017 was dedicated to discussing carers and the staff we spoke with told us they were encouraged to be proactive in identifying carers and informing them of the services available to them. The practice also held a carers’ week in June 2017 to encourage the identification of carers and promote the services offered to them. As of 9 August 2017 the practice had identified 368 patients on the practice list as carers. This was approximately 2.8% of the practice’s patient list and double the number identified in November 2016. Of those, 346 (94%) had been invited for a health review in the past nine months. This was a vast improvement on the 0% formally invited for a health review in the 12 months up to our inspection in November 2016.
• The practice demonstrated they had taken action to improve their below average satisfaction scores from the National GP Patient Survey published in July 2016. For example, the practice audited its appointments provision in January 2017 and following analysis of the results implemented various changes designed to make the appointments system more accessible to patients. This was done along with other changes not related to the audit. The results from the National GP Patient Survey published in July 2017 showed improvement in the areas previously of concern. For example, 46% of patients said they always or almost always saw or spoke with the GP they preferred compared to the Clinical Commissioning Group (CCG) average of 62% and the national average of 56%. Although still below local and national averages, this represented an improvement of 9% from the 37% satisfaction score achieved in July 2016.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 March 2017

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.
• 74% of patients on the asthma register had their care reviewed in the last 12 months. This was similar to the CCG average of 75% and the national average of 76%.
• Performance for diabetes related indicators was above the CCG and national average. The practice achieved 100% of the points available compared to the CCG and national average of 90%.
• All newly diagnosed patients with diabetes were managed in line with an agreed pathway.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review (or six monthly review if they resided in a care home) to check their health and medicines needs were being met. For those patients with the most complex needs, the named GPs worked with relevant health and care professionals to deliver a multi-disciplinary package of care.
• The practice had operated a nurse led prediabetes clinic since July 2016. In the first month of the programme, 26 patients were seen and provided with diet and lifestyle advice. After three months, 19 of the 26 patients returned for their repeat blood tests and monitoring and 14 (74%) of those had blood glucose levels (blood sugar levels) in the normal range. Also, more than half had lost weight.

Updated 20 March 2017

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 may be at risk, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates were comparable to other practices in the local area for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 80% which was similar to the CCG and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There were eight week post-natal checks for mothers and their children.
• A range of contraceptive and family planning services were available.

Updated 20 March 2017

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.
• The practice provided comprehensive health assessments to housebound patients aged 75 years and over. The practice had identified 47 such patients and since April 2016, 30 (64%) had received their comprehensive assessments.
• Older people had access to targeted immunisations such as the flu vaccination. The practice had 2,011 patients aged over 65 years. Of those 1,431 (71%) had received the flu vaccination at the practice in the 2015/2016 year. A further 33 patients were recorded as having received the vaccination elsewhere.
• There were 17 care homes in the practice’s local area and patients of the practice resided in 15 of them at the time of our inspection. The GPs visited as and when required to ensure continuity of care for those patients. For one of the homes for residents with increased needs there were two scheduled visits each week. The practice provided six monthly reviews to all its patients living in care homes, including a full medicines review.

Updated 20 March 2017

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.
• The practice offered online services such as appointment booking and repeat prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
• There was some additional out of working hours access to appointments to meet the needs of working age patients. There was extended opening at Harvey House Surgery every Saturday from 8.40am to midday for GP and nurse pre-bookable appointments. There was no lunchtime closure at Harvey House Surgery.
• The practice provided 15 minute appointment slots to all patients as standard.

Updated 20 March 2017

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

• 98% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was considerably above the CCG average of 85% and national average of 84%.
• Performance for mental health related indicators was above the CCG and national averages. The practice achieved 100% of the points available compared to the CCG average of 95% and the national average of 93%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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 support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• A dual qualified NHS and Improving Access to Psychological Therapies (IAPT) counsellor was based at Harvey House Surgery twice each week. Patients could access this service to obtain psychological and emotional counselling and advice through referral from the GPs.
• There was a GP lead for mental health.

Updated 20 March 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 those with a learning disability. There were 71 patients on the practice’s learning disability register at the time of our inspection. Of those, all had been invited for and 49 (69%) had accepted and received a health review in the past 12 months.
• The practice offered longer appointments for patients with a learning disability and there was a GP lead for these patients.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access 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.
• Additional information was available for patients who were identified as carers and there was a nominated staff lead for these patients.
• The practice had identified 178 patients on the practice list as carers. This was approximately 1.4% of the practice’s patient list. Of those, none had been formally invited for and two (1%) had received a health review in the past 12 months. The number of carers receiving a health review could be improved.