Harraton Surgery

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We carried out an announced assessment of 6 quality statements under the effective key question and found: While monitoring of patient care had improved in some areas, it had deteriorated in others. We found several areas where the clinical searches suggested that processes in place for clinical monitoring of patients and assessing needs were inadequate, for example the needs of women of childbearing age taking medications which may cause birth defects. We saw there were meetings taking place, however we did not see completed minutes for every meeting. Staff we spoke with understood their duties regarding consent. Staff had access to up-to-date policies and guidance via the practice’s intranet system. Online training was also available to keep people up-to-date, however we saw there were gaps in the training matrix where some regular mandatory training had been missed. Two clinical audits had been conducted since June 2023.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback we saw from patients was generally positive in this area. The practice could only provide results for the Friends and Family test for June, but we saw that most patients reported their needs had assessed, with only four of the 65 responses reporting that this was not the case. Data from the 2024 National GP patient survey showed that 83% of people completing the survey felt the healthcare professional they saw or spoke to was good at considering their mental wellbeing during their last general practice appointment. This was higher when compared to local and national averages. However, our observations raised some concerns regarding assessment of needs at the service.

Staff told us they used digital flags within the care records system to highlight any specific individual needs and where reasonable adjustments were needed, such as the requirement for longer appointments or for a translator to be present. Staff checked people’s health, care, and wellbeing needs during health reviews. However, our observations raised some concerns regarding assessment of needs at the service.

At the last inspection in June 2023, we saw from the remote searches and review of clinical records we carried out that some patients did not always receive the appropriate monitoring at the required intervals. At this assessment in June 2024 we saw that while this had improved in some areas it had deteriorated in others. We found several areas where the clinical searches suggested that processes in place for clinical monitoring of patients and assessing needs were inadequate, for example the needs of women of childbearing age taking medications which may cause birth defects. However, flu, shingles and pneumonia vaccinations were offered to relevant patients, and the practice had systems to inform eligible patients to have the meningitis vaccine, for example before attending university for the first time. All patients with a learning disability were offered an annual health check.

Data from the 2024 National GP patient survey showed that of those people that responded to the survey, 96% felt their needs were met during their last general practice appointment. This was higher than local and national averages. Patient feedback we viewed during this assessment was mostly positive about the care received. However, our observations raised some concerns regarding evidence-based care at the service.

Staff told us they had access to up-to-date guidelines. They also attended training sessions within the practice and external opportunities. However, we saw there was a lack of oversight to ensure mandatory training was kept up to date.

Staff had access to up-to-date policies and guidance via the practice’s intranet system. Online training was also available to keep people up-to-date, however we saw there were gaps in the training matrix where some regular mandatory training had been missed. There was a programme of quality improvement at the practice. They had completed 2 audits since June 2023 around the use of aspirin in primary prevention and dosing of Gabapentin & Pregabalin. However, despite this we saw there were process issues which meant monitoring of patients did not always take place in line with evidence and guidance. For example, 8 patients out of the 15 on methotrexate were overdue 12-weekly monitoring, and one patient received a 6-month supply, despite NHS England advice to issue no more than a 3-month supply. We saw that inhalers had been overprescribed and the following-up of patients with suspected pre-diabetes had not always been taking place in line with recommendations.

Data from the 2024 National GP patient survey showed that 90% of people completing the survey felt the healthcare professional they saw had all the information they needed about them during their last general practice appointment, which was in line with local and national averages. However, our observations raised some concerns regarding how teams worked together.

Staff were positive about how they worked together. They told us that all staff within the different teams at the practice worked well together, and that advice and support was available to staff when it was needed. Staff felt communication had improved over the past year since the last inspection. At the June 2023 inspection we saw there were no formal meeting arrangements in place. At this assessment we saw there were meetings taking place, however we did not see completed minutes for every meeting which had been scheduled and therefore we could not be sure how frequently these were taking place.

There was some concern about how well the practice worked with others to safeguard people. At the last inspection in June 2023, we saw that the designated safeguarding lead nurse for the local Integrated Care Board (ICB) had carried out an audit of safeguarding at the practice in November 2022. There was an action plan in place for improvement. At this assessment in June 2024, partners reported that there was still room for improvement in this area.

Care was delivered and reviewed in a coordinated way when different teams, services or organisations were involved, and we saw that patients received consistent, coordinated, person-centred care when they moved between services. However, there was a lack of evidence that safeguarding meetings were taking place with an appropriate lead member of staff, and therefore that the practice was working as well as they could with other teams to safeguard people.

Patients felt supported to manage their health and wellbeing. Patient feedback we viewed was positive about advice and guidance provided by clinical staff. Data from the 2024 National GP patient survey showed that 75% of people completing the survey felt they have had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses. This was in line with local and national averages. Of those who responded, 83% say the healthcare professional they saw or spoke to was good at considering their mental wellbeing during their last general practice appointment. This is above local and national averages.

Staff told us they would opportunistically offer additional monitoring and treatment where it was indicated to support the overall health of the patient. We were told staff at the practice were given “champion” roles to encourage and support patients to make healthier choices.

The practice identified patients who may need extra support and directed them to relevant services. This included patients in the last 12 months of their lives, patients at risk of developing a long-term condition and carers. However, we did see that in some cases, patients who were at risk of developing diabetes had not been followed up. There was information on the practice website about support groups and information to support healthier living. Staff told us they would print information out for patients, however, this would rely on the patient asking for the information, which may not always be appropriate. The practice had appropriate processes in place to invite patients in for their immunisations/cancer screening and health screening. Staff monitored if patients had attended and took action when patients did not attend. However, the practice were failing to meet the 80% UK Health and Security Agency target for cervical screening, currently at 69.3%. At the last inspection in June 2023, the practice were achieving 68.8% for their cervical screening, and had explained this was due to a lack of nursing staff to provide the service. The practice now had a nurse in place and expected this figure to rise.

Data from the 2024 National GP patient survey showed that 96% of people completing the survey felt their needs were met during their last general practice appointment. This was higher than local and national averages. Patient feedback from the practice’s Friends and Family survey was mostly positive about care and treatment received. However, they could only provide one month’s worth of results. However, we saw that there were issues with monitoring patients that needed to be improved.

At the last inspection in June 2023, the practice were achieving 68.8% for their cervical screening, and had explained this was due to a lack of nursing staff to provide the service. At this assessment in June 2024, a nurse had been appointed, and the cervical screening rate was beginning to improve, although it was still below the national target of 80%. Staff told us they monitored and acted on information from various sources including patient feedback, clinical audits, complaints and incidents. However, there was limited patient feedback due to there being no Patient Participation Group, and at the time of the assessment, only one month’s feedback was available from the Friends and Family Survey. We saw that there were issues with monitoring patients that needed to be improved.

At the last inspection in June 2023, we saw that some patients did not always receive the appropriate monitoring at the required intervals. At this assessment in June 2024 we saw that while this had improved in some areas it had deteriorated in others. We found several areas where the clinical searches suggested that processes in place for clinical monitoring of patients and assessing needs were inadequate, for example the needs of women of childbearing age taking medications which may cause birth defects, or following up patients who had been identified as being at risk of having diabetes.

Our monitoring showed that the practice was in line with national averages in terms of monitoring for breast and bowel cancer, and with childhood vaccination rates. However, they were below average in terms of numbers of patients screened for cervical cancer (69.3%. National target: 80%). We saw that monitoring of patients with some long-term conditions and certain types of medications needed to improve.

In the GP national patient survey, 94% of patients who responded said they had been involved as much as they wanted to be in decisions about their care and treatment. Documents we saw suggested people understood their rights around consent to the care and treatment they were offered. People’s views and wishes were taken into account when their care was planned. However, we saw some staff had not recently completed mandatory training around consent.

Staff we spoke with understood their duties regarding consent. Clinicians understood the requirements of legislation and guidance when considering consent and decision making. They told us they supported patients to make decisions. Where appropriate, they assessed and recorded a patient’s mental capacity to make a decision. However, we saw some staff had not recently completed mandatory training around consent.

Our clinical review of patient records where a do not attempt cardiopulmonary resuscitation (DNACPR) decision had been recorded identified that, where possible, patients views had been sought and respected. Where necessary, people with legal authority or responsibility made decisions within the requirements of the Mental Capacity Act 2005. This included the duty to consult others such as carers, families and/or advocates, where appropriate. However, records we viewed did not show that all relevant staff had completed up-to-date training around consent.