Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chells Surgery on 18 October 2016. Overall the practice is rated as good.

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. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was delivered 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• Picture signage was used around the practice for those patients who had difficulty reading. For example, there were pictures of the different specimen pots used by patients above the different boxes they put them in ready for collection or testing.
• The practice had a newly refurbished and extended building that was designed with 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 developed an enhanced support service, this consisted of a team of five senior administrative staff (GP assistants) who were able to provide additional support and guidance to patients who had complex health and social care needs. For example, palliative care patients, the elderly, patients with long term conditions and those experiencing vulnerable circumstances. The service provided a single point of contact for the patient, their carer and any other provider involved in their care. Patients referred to the service were able to order repeat prescriptions over the telephone. Members of the team were able to co-ordinate services and equipment for patients. For example, community nurses, MacMillan nurses and Hertshelp, a local advice service. At the time of the inspection there were 247 patients receiving enhanced support. The practice kept a folder of compliment letters and cards they received from patients. We saw feedback from patients to show that the enhanced support service was positive.

The areas where the provider should make improvement are:

• Continue to review the data from the Quality and Outcomes Framework (QOF) and make improvements in relation to long term conditions where they are below others when compared to the local and national averages.
• Ensure consent for procedures, including verbal consent, is documented in the patient’s notes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

When we previously inspected Chells Surgery on 30 January 2014 we found that the provider was not compliant with a number of aspects of the essential standards relating to cleanliness and infection control, the management of medicines and the assessment and monitoring of quality. We required the provide to make improvements. The provider wrote to us and told us they would be compliant by 31 March 2014. We inspected again on 2 May 2014 to see whether these improvements had been effective.

We found that there was a system in place to manage the cleaning processes and equipment. All staff, including the cleaning staff, had received training in infection control. There was clear guidance about cleaning times and methods and these were followed. The practice manager had implemented a system of checking that assessed the effectiveness of the cleaning processes. Potentially infectious material was properly labelled, stored and disposed of.

The storage and recording arrangements for medicines, including controlled drugs and emergency medicines enabled the provider to properly check expiry dates. Medicines were held securely and their stocks were monitored by an effective dual level auditing system that the provider had introduced since our last inspection.

The provider had improved the quality monitoring processes at the practice. This included an additional layer of supervision, or oversight of the key procedures that were routinely checked by the practice staff. The provider had a more robust system for recording and tracking significant events and complaints. Staff NHS smartcards were used appropriately and securely.

We saw that patients had access to various health care leaflets and information related to their health care needs.

One patient told us, “Everything’s been fine. Most of the time I can get the appointments I want. I usually see the same doctor.”

We toured the practice and saw that clinical waste and the sharps bins were stored in the basement of the practice. We noted that the door to the basement was not lockable.

We found that controlled and non-controlled drugs were not kept safely or secured appropriately. We checked two GPs’ consultation rooms and found medicines which had been returned by patients. The provider did not have sufficient measures in place to ensure the safe, secure storage and appropriate disposal of medicines.

We looked at the records of three staff members. We found that all three staff had completed appraisals.

One staff member said, “We have regular staff meetings which are really effective.”

We saw that some complaints had not been acknowledged within the timescales stated in the complaints policy. The practice had not consistently reviewed policies and procedures effectively in order to maintain an appropriate level of assurance.