Ashley Medical practice was previously inspected in November 2014 and July 2015 and was rated good overall and in all domains.

At this inspection in April 2018 the practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Ashely Medical Practice on 25 April 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

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.
• 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.
• There was a strong focus on improvement at all levels of the organisation.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Staff were supported in personal development and training and received regular appraisals.
• Data from the Quality and Outcomes Framework (QOF) showed the results for practice management of patients with long-term conditions were good.
• Information about services and how to complain was available and easy to understand.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Patients said they were able to book an appointment that suited their needs. Pre-bookable, on the day appointments, home visits and a telephone consultation service were available. Urgent appointments for those with enhanced needs were also provided the same day.
• The practice was equipped to treat patients and meet their needs.
• The patient participation group (PPG) had won the PPG of the year award 2017 from the National Association of Patient Participation Groups.

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 of this practice on 13 November 2014. Breaches of legal requirements were found during that inspection within the safe domain. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:

• Record all significant events and ensure that regular review meetings are held and documented to demonstrate that the practice had learnt from these and that findings are shared with relevant staff.
• Record all care plans onto patient electronic records in a way that allows for the sharing of information.

Our previous report also highlighted areas where the practice should improve:-

• Record minutes of reception staff meetings
• Record when staff have read and understood policies and procedures including when these are updated
• Ensure newly recruited staff sign a health declaration.
• Ensure all staff is offering the chaperone services to all patients.
• Ensure all staff complete training on safeguarding vulnerable adults.

We undertook this focused inspection on 14 July 2015 to check that the provider had followed their action plan and to confirm that they now met legal 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 on our website at www.cqc.org.uk

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

• Significant events were a standing agenda item for discussion at the practice meeting held every three weeks.
• Minutes were kept of the significant events meeting discussions and reflective learning was recorded.
• All care plans were recorded into the patients’ electronic notes.
• Where specific information was needed for the patient, for example medication information, this was printed from the patient electronic record to give to the patient.
• The practice had organised chaperone training for staff. All staff who undertook chaperone duties would be subject to a criminal record check via the Disclosure and Barring Service.
• Most staff had completed training on safeguarding vulnerable adults and dates were in place for those that were yet to take place.
• We saw that minutes of reception staff meetings were being recorded.

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 Ashlea Medical Centre – Linden House on 13 November 2015. Overall the practice is rated as good.

The provider has two practice locations. Linden House situated in Leatherhead and Gilbert House situated in Ashtead. We inspected both practices separately. This report relates to Linden House. Gilbert House was inspected on 5 November 2014 the details of which can be read in a separate report.

Linden House provides primary medical services to people living in Leatherhead. The practice is situated in a residential area.

At the time of our inspection there were approximately 9,300 patients registered at the service with a team of five GP partners who held managerial and financial responsibility and two salaried GPs. Linden House is a GP training practice and at the time of the inspection was providing training and support for two registrars.

The inspection team spoke with staff and patients and reviewed policies and procedures implemented throughout the practice. The practice was responsive to the needs of the local population and engaged effectively with other services. There was a culture of openness and transparency within the practice. The practice was committed to providing high quality patient care and provided good support and training to staff to facilitate this. The practice is required to record significant events onto an annual summary and we saw this was not routinely being completed. GP’s told us all significant events and lessons learnt were discussed during daily meetings, however, these meetings were not recorded. We noted that some care plans were hand written and not being recorded on to patient’s electronic records. This did not allow for other clinicians to see actions agreed with the patient for their ongoing care.

Our key findings included:-

• Patients told us they felt they were treated with respect and dignity
• Staff were mindful of patient privacy and confidentiality was maintained.
• Patients told us there was a wide range of appointments, including urgent appointments available the same day.
• Infection control audits and cleaning schedules were in place and the practice was seen to be clean and tidy
• An active patient participation group working in partnership with the practice

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Record all significant events and ensure that regular review meetings are held and documented to demonstrate that the practice had learnt from these and that findings are shared with relevant staff.

In addition the provider should:

• Record minutes from reception staff meetings
• Ensure all staff are offering the chaperoning services to all patients
• Ensure all staff complete safeguarding for Vulnerable Adults training
• Record all care plans onto patient electronic records in a way that allows for sharing of information

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice