Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 15 December 2015. Breaches of Regulatory requirements were found during that inspection within the safe and effective domains. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the regulatory responsibilities in relation to the following:

• To ensure that all staff received appropriate training commensurate to their role and that an effective system was in place to monitor training needs and to take the appropriate actions to ensure training was up to date.

• To ensure that the practice had a robust system for securing and tracking the use of prescription forms used by the practice.

We undertook this focused inspection on 18 August 2016 to check that the provider had followed their action plan and to confirm that they now met regulatory requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ashdown Forest Health Centre on our website at www.cqc.org.uk.

This report should be read in conjunction with the last report published in February 2016. Our key findings across the areas we inspected were as follows:-

• We saw that there was a robust system in place to ensure all staff undertook required training and that there was an effective system in place to monitor this.

• We saw evidence that prescriptions forms were securely stored at all times and that there was an effective system in place that tracked these forms from entry into the practice to their subsequent use.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ashdown Forest Health Centre on 15 December 2015. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Mandatory training for staffhad not been completed and monitored to ensure that time frames for renewal do not lapse. This includes training in respect of fire safety, first aid, basic life support,infection control and information governance.

• The provider did not maintain a secure storage and recording system to track prescription pads.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed , with the exception of prescription security and staff refresher training in mandatory training
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Feedback from patients about their care was consistently and strongly positive.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• 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 provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

• The practice had worked with a 28 bed nursing home in the local community. Making weekly visits to undertake a comprehensive review of individual treatment and medicines management for nursing home residents. This had reduced hospital admissions and out of hours call outs by 53% in the year 2014/15 when compared to the previous year.

The areas where the provider must make improvement are:

• The provider must ensure that mandatory training for staff is completed and monitored to ensure that time frames for renewal do not lapse. This includes training in respect of fire safety, first aid, basic life support,infection control and information governance.

• The provider must maintain a secure storage and recording system to track prescription forms.

In addition the provider should:

• Continue to work with their practice list in raising the uptake of childhood immunisations ensuring all possible steps are taken to engage with patients declining vaccination.

• Review how they engage with members of their practice list who do not currently embrace conventional medicine.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

At this inspection we spoke with the Practice manager, deputy manager, eight members of staff and seven patients. Comments from patients included "Fantastic", "No complaints", "Staff are polite and respectful".

We found that patients were treated with respect and their privacy and confidentiality was maintained. There was information available to patients about the Practice, medical conditions and external support.

Care and treatment was planned and delivered in a way that was intended to ensure patient's safety and welfare. Consultations were recorded appropriately and patients were referred to specialists if required. There was a clear appointment system but some patients were unhappy that they could not always see their choice of GP at time they preferred.

Staff at the Practice had received training in protecting children and safeguarding adults. The provider took appropriate action where safeguarding issues were identified. Patients were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that staff were supported in their roles and had opportunities to discuss their development. Comments from staff included "I find it good here" and "It's a fantastic team".

The provider had an effective system to regularly assess and monitor the quality of service that patients received. The Practice sought feedback from patients and took appropriate action to make improvements where these were identified.

We reviewed the information available to us about Ashdown Forest Health Centre on 11 June 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.