The Care Quality Commission
  • Doctor
  • GP practice

Archived: Harford Health Centre

Overall: Good read more about inspection ratings

115 Harford Street, London, E1 4FG (020) 7790 1059

Provided and run by:
Harford Health Centre

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

All Inspections

02 November 2020

During a routine inspection

We carried out an announced comprehensive inspection of Harford Health Centre on 2 November 2020.

The practice was last inspected on 20 February 2020 where we rated it as inadequate overall and placed the practice in special measures.

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.

At this inspection, we have rated the practice as good overall.

We rated the practice as requires improvement for providing safe services because:

  • We identified some examples where GPs had prescribed two types of medicine without evidence of all of the required monitoring having been completed. We also identified limited evidence documented within consultation notes that GPs had discussed with patients the addictive potential of specific types of controlled drugs and the possibility of reducing the medicine. Immediately after our inspection, the practice took appropriate action to address these areas.
  • Following our previous inspection the practice had put in place a new system to monitor safety alerts. However, we found evidence of prescribing contrary to some older safety alerts. Prior to our site visit, the practice had taken action to contact patients and amend prescriptions to ensure safety.
  • Staff had completed adult and child safeguarding training to an appropriate level for their role.
  • Recruitment checks were carried out in accordance with regulations.
  • A record of staff vaccination was maintained.
  • The practice held appropriate emergency medicines and there was evidence of regular checks of stock levels and expiry dates.
  • Test results were reviewed in a timely manner.
  • Appropriate safety checks and procedures had been put in place in relation to the premises.

We rated the practice as good for providing effective services because:

  • The practice reviewed and monitored the effectiveness and appropriateness of the care and treatment it provided through quality improvement activity.
  • The practice was able to demonstrate that staff had the skills, knowledge and experience to carry out their roles.
  • Staff told us they were given protected time to complete training and that the practice encouraged staff to upskill.
  • Staff worked together and with other organisations to deliver effective care and treatment.
  • Staff helped patients to live healthier lives.

We rated all population groups as good for providing effective services, except for the population group of ‘working age people’, which we rated as requires improvement due to the low uptake for cervical screening.

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

  • The practice had discussed the GP Patient Survey results for 2020 and had put in place a documented action plan to try and improve patients’ experience.
  • There had been an improvement in the GP Patient Survey results for 2020, as compared to 2019, for questions relating to healthcare professionals being good at listening to patients and patients having confidence and trust in the healthcare professionals they saw.
  • The practice had carried out its own patient feedback exercise between April and September 2020, the results of which were positive.
  • Feedback we received from members of the Patient Participation Group (PPG) advised that the practice meets the needs of and listens to its patients.

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

  • The practice had discussed the GP Patient Survey results for 2020 and had put in place a documented action plan to try and improve patients’ experience.
  • The practice had completed a quality improvement project to improve access, which included trialling a ‘total triage’ model for booking appointments.
  • The practice had implemented the ‘total triage’ model from October 2020 and feedback we heard from staff and members of the Patient Participation Group (PPG) was very positive about this new system.
  • Members of the PPG told us patients were able to easily access appointments.
  • The practice had carried out its own patient feedback exercise between April and September 2020, which included specific questions around telephone access and appointments, the results of which were positive.
  • Complaints were listened and responded to and used to improve the quality of care.

These areas affected all population groups, so we rated all population groups as good for providing responsive services.

We rated the practice as good for providing well-led services because:

  • Following the last inspection there had been changes to the partnership at the practice, with the former lead GP retiring. The practice had engaged in sessions with an external consultancy company, to strengthen and develop the leadership team, and these sessions included incoming partners who had recently joined the practice.
  • Following the previous inspection in February 2020, the practice had created a specific action plan which detailed the risks that had been identified; this plan was monitored and updated to ensure that risks were addressed and escalated where necessary.
  • We saw that, following changes to the leadership team, partners’ involvement and oversight had improved, including in relation to the safety of the premises.
  • All of the specific concerns we identified at the previous inspection had been satisfactorily addressed at this inspection.
  • Although we identified some issues regarding management of specific medicines, the practice took prompt action to resolve this.
  • Staff told us they were able to raise concerns and that management and leaders were approachable.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Continue to take action to improve patients’ access to care and treatment, particularly in relation to contacting the practice by telephone.
  • Work to improve the uptake rate for cervical screening.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

20 Feb 2020

During a routine inspection

We carried out an announced comprehensive inspection of Harford Health Centre on 20 February 2020 following our annual review of the information available to us about the practice.

The practice was last inspected on 11 May 2017 and we rated the practice as good overall.

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 have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

  • The system for receiving and acting upon safety alerts was not effective.
  • We found ineffective monitoring and unsafe prescribing of some high-risk medicines.
  • Some clinicians had not reviewed test results in a timely manner.
  • There were some gaps in staff training and staff had not completed safeguarding training to the appropriate level for their role.
  • There was no record of immunity status for staff members.
  • The practice had a system in place to ensure that recruitment checks were carried out for new starters, however whilst the practice manager was on leave the practice had failed to carry out recruitment checks as required.
  • The practice had not assessed the need for certain medicines to be kept for use in an emergency.
  • There was a lack of safety checks and procedures in place relating to the premises and limited oversight of checks and actions carried out by the building landlord.

We rated the practice as inadequate for providing well-led services because:

  • Some leaders demonstrated a lack of awareness of and oversight of potential risks, as evidenced by policies and procedures not being maintained whilst the practice manager was on leave.
  • We heard evidence that some of the partners needed more involvement in the overall running and governance of the practice and had not taken on responsibilities when the practice manager was off work, nor had they assured themselves that those staff members who were covering the practice manager were capable of doing so.
  • The provider lacked oversight and knowledge of systems and procedures relating to the safety of the premises, in that they had not assured themselves that the premises were safe for their patients and staff by obtaining evidence of risk assessments completed and actions resolved.

We rated the practice as requires improvement for providing caring services because:

  • The practice’s national GP Patient Survey Results for 2019 were below national averages for questions relating to how patients felt they were treated by clinicians and their overall experience of the practice. The provider was not aware of these results, they had not been discussed as a practice team, and there was no action plan in place to address these low results.

We rated the practice as requires improvement for providing responsive services because:

  • The practice’s national GP Patient Survey Results for 2019 were below national averages for questions relating to access. The provider was not aware of these specific results, they had not been discussed as a practice team, and there was no action plan in place to address these low results (albeit the practice recognised that access has been an ongoing issue).
  • Patients’ access to care and treatment had been raised as an area for improvement at a previous CQC inspection in March 2016, however feedback from patients about access demonstrated that this was still an issue.

These areas affected all population groups, so we rated all population groups as requires improvement for providing responsive services.

We rated the practice as good for providing effective services because:

  • The practice reviewed and monitored the effectiveness and appropriateness of the care and treatment it provided through quality improvement activity.
  • Clinicians had completed role-specific training in order to deliver effective care.
  • Staff told us they were given protected time to complete training and that the practice encouraged staff to upskill.
  • The practice obtained consent to care and treatment in line with legislation and guidance.
  • Staff helped patients to live healthier lives.

These areas affected all population groups, so we rated all population groups as good for providing effective services.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Formalise oversight of clinicians and staff employed in advanced clinical practice through regular documented record and prescribing checks.
  • Ensure patient notes are summarised in a timely manner.
  • Work to improve the uptake rate for cervical screening.
  • Ensure staff monitor refrigerator temperatures as per Public Health England guidance.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

11 May 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harford Health Centre on 1 March 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 1 March 2016 inspection can be found by selecting the ‘all reports’ link for Harford Health Centre on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 11 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 1 March 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.

Our key findings were as follows:

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety. Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The practice had acted upon the findings of our previous inspection and engaged in a quality improvement programme to review processes and systems specifically around access and develop internal efficiencies. The practice had reported a positive impact on patient satisfaction from feedback through internal surveys, the patient participation group and the Friends and Family Test.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

In addition the provider should:

  • Continue to monitor access to appointments and contacting the surgery by telephone to ensure that improvement measures put in place continue to impact positively on patient satisfaction.

  • Continue to monitor patient uptake of the cervical screening programme.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

1 March 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harford Health Centre on 1 March 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 an effective system in place for reporting and recording significant events.
  • Although risks to patients who used services were assessed, the systems and processes to address these risks were not in all instances implemented well enough to ensure patients were kept safe, specifically in relation to recruitment checks, staff appraisals and mandatory training.
  • Data from the National GP Patient Survey showed patient outcomes were significantly lower than local and national averages specifically in relation to appointment access and getting through to the practice on the telephone.
  • Although some audits had been carried out, there was no evidence of an ongoing quality improvement programme to ensure outcomes for patients were maintained and improved.
  • 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.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a leadership structure that had named members of staff in lead roles. However, some governance arrangements needed development specifically in relation to recruitment and mandatory training.
  • The practice proactively sought feedback from patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • The practice had a number of policies and procedures to govern activity, but some were overdue a review.

The areas where the provider must make improvement are:

  • Ensure recruitment arrangements include all necessary employment checks for all staff.

The areas where the provider should make improvement are:

  • Ensure there is an effective system for recording to whom prescription pads are issued.
  • Develop a system to ensure mandatory training is up-to-date.
  • Review the Business Continuity Plan.
  • Develop an ongoing quality improvement programme including clinical audit and re-audit to ensure outcomes for patients are maintained and improved.
  • Carry out staff appraisals annually and provide structured opportunities for staff to review their performance with their manager.
  • Develop a carers' register to ensure information, advice and support is made available to them.
  • Improve the availability of non-urgent appointments and review the telephone system to ensure patients can access the surgery in a timely manner.
  • Review and update practice policies and procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

11 December 2013

During a routine inspection

We spoke with a GP partner, a nurse practitioner partner, a phlebotomist, a receptionist and the interim practice manager. We also spoke with ten people using the service and the chair of the practice's patient participation group.

The patients we spoke with said they were happy with the service. One patient said, "the doctors are good. I ask so many questions and it's fine." Another patient said, "I am quite happy with the service. It's quite all right." Patients told us the staff were friendly and respected their privacy. The practice had recently moved into improved premises which patients liked. The environment was clean. There were appropriate arrangements in place to handle emergencies.

Staff received support for professional development. Staff told us they were well supported by their managers and the GP partners. We were told that the practice manager and doctors were approachable and always happy to discuss any issues.

The practice had a range of quality monitoring systems in place. The practice regularly asked patients for their views about the service and effectively involved the patient participation group. The practice team conducted audits and used performance data, incidents, comments and complaints to improve the quality and safety of care.