This practice is rated as Good overall. (Previous inspection 08/2017 – Good)

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 Chestnut Practice on 15 August 2017. The overall rating for the practice was good. The practice was rated requires improvement for providing safe services. The full comprehensive report on the August 2017 inspection can be found by selecting the ‘all reports’ link for Chestnut Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 10 April 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 15 August 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. Overall the practice remains rated as good.

At this inspection we found:

• The practice had addressed all concerns that were identified at our previous inspection.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When significant events or incidents did happen, the practice learned from them and improved their processes.
• The practice had implemented a system to ensure safety alerts were disseminated and acted on.
• The practice had developed a protocol to ensure the monitoring of patients taking lithium was in line with current national guidelines.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and the majority of patients reported that they were able to access care when they needed it.
• There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Ensure all staff adopt a documented approach to managing test results.
• Ensure all staff are aware of ‘red flag’ sepsis symptoms that might be reported by patients and know how to respond.
• Continue to review ways to improve patient satisfaction with the availability and punctuality of appointments.
• Ensure all staff are aware of their roles and responsibilities.

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 Chestnut Practice on 12 January 2016. The practice was rated as good for providing safe, caring, responsive and well-led services, and requires improvement for providing effective services. Overall the practice was rated as good. The full comprehensive report on the January 2016 inspection can be found by selecting the ‘all reports’ link for Chestnut Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow up inspection on 15 August 2017 to check for improvements since our previous inspection. The practice is now rated as good for providing effective, caring, responsive and well-led services, and requires improvement for providing safe services. 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 a system in place for reporting and recording significant events. However, we noted a significant event described by staff had not been documented.
• Risks to patients were assessed and well managed, with the exception of those relating to managing safety alerts, the monitoring of patients taking lithium, and tracking blank prescription forms.
• Staff were aware of evidence based guidance. Although, some GPs were not aware of updated guidance relating to family planning.
• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• There was evidence of quality improvement activity including clinical audit.
• 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.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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. However, some patients told us there were delays after their appointment time to be seen. This was reflected in results from the national GP patient survey where the punctuality of appointments was rated lower than local and national averages.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

• Ensure care and treatment is provided in a safe way to patients. For example, managing safety alerts, monitoring patients on high risk medicines, and tracking blank prescription forms.

The areas where the provider should make improvement are:

• Review the system in place to ensure all significant events are recorded and reviewed.
• Review the system in place to ensure the accuracy of fridge temperatures.
• Raise staff awareness of updated evidence based guidance.
• Review ways to improve patient satisfaction with the availability and punctuality of appointments.
• Advertise that a translation service is available to patients on request.

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 Cheshunt practice on 12 January 2015. 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.
• Risks to patients were assessed and well managed.
• 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.
• 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.

The areas where the provider must make improvements are:

• Ensure staff receive appraisal as is necessary to enable them to carry out the duties they are employed to perform.

The areas where the provider should make improvement are:

• Ensure QOF scores are improved and address poor performance that have been identified to the care of patients with diabetes.

• Ensure a safer system of storing prescription pads is in place.

• Ensure they maintain a record of discussions and decisions from Multi-disciplinary meetings.

• Ensure they carry out clinical re-audits to improve patient outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice