We carried out an announced comprehensive inspection at Addiscombe Road Surgery on 24 January 2019 as part of our inspection programme.

At the last inspection on 20 December 2017 we rated the practice as requires improvement for providing safe services because:

• there was not a clear system in place to manage safety alerts
• not all risks to patient safety from the premises had been adequately assessed and mitigated.

At this inspection, we found that the provider had satisfactorily addressed these areas.

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 good overall and good for all population groups.

From the inspection in December 2017 and January 2019 we found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

When we inspected in December 2017 we identified some areas that were not breaches of regulations but where we recommended action. These were:

• Develop a system to receive, review and implement evidence based guidelines.
• Consider recording clinical discussions.
• Review processes for exception reporting for patients with long-term conditions.
• Review the process for obtaining consent for clinical procedures to include them being appropriately recorded.
• Improve access for patients who are disabled.
• Develop a system to record verbal complaints.

At this inspection we found that the practice had acted on all of the recommendations and most were completed. Work to improve access to reduce the rates of exception reporting was still ongoing. Although the overall rate of exception reporting had reduced, the rate of some indicators remained higher than average.

Access for patients with disabilities had improved, with the opening of a second surgery. The Addiscombe Road Surgery premises remained difficult for patients who used mobility aids to access. The practice told us of adjustments made for individual patients and of plans to ensure the practice operated only from suitable premises.

Whilst we found no breaches of regulations, the provider should continue to:

• Review processes for exception reporting for patients with long-term conditions.
• Continue to develop plans to ensure the practice operates only from suitable premises.

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

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection October 2014 rated overall as Requires Improvement; this inspection related to the old provider)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Addiscombe Road Surgery on 20 December 2017 as part of our regular inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. However they did not have a clear system in place to manage medicines and safety alerts.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines; however the provider did not have a clear system in place to keep clinicians up to date with current evidence-based practice.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a focus on continuous learning and improvement.

The areas where the practice must make improvements are:

• Ensure there is a system in place to receive, implement and monitor the implementation of medicines and safety alerts.
• Ensure patient safety at all times, including having a system to call for help from the patient toilet and

The areas where the provider should make improvements are:

• Develop a system to receive, review and implement evidence based guidelines.
• Consider recording clinical discussions.
• Review processes for exception reporting for patients with long-term conditions.
• Review the process for obtaining consent for clinical procedures to include them being appropriately recorded.
• Improve access for patients who are disabled.
• Develop a system to record verbal complaints.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice