We carried out an announced comprehensive inspection at Chiddingfold Surgery on 5 December 2018 as part of our inspection programme.

At the last inspection in November 2017 we rated the practice as requires improvement for providing safe and well-led services because:

• Safety alerts were not always actioned.
• Action was not always taken in relation to vaccine fridge temperatures being outside of the required range.
• Systems to manage risk were not always effective.

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 except for the care for older people which we found outstanding.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• The arrangements for dispensing medicines at the practice kept patients safe.
• The practice acted on and learned from external safety events as well as patient and medicine safety alerts.
• Patients received effective care and treatment that met their needs.
• The practice provided health promotion initiatives within the local community. This included attending the local events to provide advice and monitoring such as blood pressure testing and sexual health education to a local school.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Feedback from patients was positive and the results from the national GP patient survey showed a positive variation in patients’ experience of accessing the service.
• 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.

We rated the practice as outstanding for providing services to older people because:

• The practice demonstrated a 32% reduction in elderly patients accessing care home services and a 52% reduction in accident and emergency attendance since the practice had participated in a local frailty initiative.

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

• Continue to work to improve the uptake of childhood immunisations.
• Ensure that near misses within the dispensary and the learning from them are recorded.

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 requires improvement overall. (Previous inspection October 2014, rating – Outstanding)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Good

Are services well-led? – Requires improvement

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 – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

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

We carried out an announced inspection at Chiddingfold Surgery on 2 November 2017. The inspection was carried out as part of our inspection programme

At this inspection we found:

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence- based guidelines.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• 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.

• The practice had 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, these were not always effective.

• Staff were motivated and inspired to offer kind and compassionate care and respected the totality of their needs.

• Data from the national GP patient survey published July 2017 showed patients rated the practice higher than others for some aspects of care.

• The practice proactively sought feedback from staff and patients, which it acted on.

• The patient participation group was also active. The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). For example, the practice provided an after school clinic for children one afternoon a week.

• The practice recognised that the patient’s emotional and social needs were as important as their physical needs.

• The practice ensured that appropriate patients, those deemed to be at risk or especially frail, received a proactive anticipatory care plan in partnership with the patient and any carer. The practice ensured that all unplanned admissions were contacted within three days of being discharged to review any care required.

• One GP delivered an annual sex education talk to a local primary school whilst another GP delivered an annual talk to a local special needs school on how to access their services.

• The practice had systems to inform eligible patients to have the meningitis vaccine. To assist in the uptake of this vaccination the practice ran late afternoon/early evening clinics to fit in with students who would be at college throughout the day. The practice used these sessions to also discuss any sexual health needs of the patients.

• The practice hosted weekly counselling sessions to enable local access for patients.

• The practice was proactive in undertaking clinical audit to improve patient care.

• The practice had an effective infection control process in place and acted on issues found during audits.

• The practice ensured all recruitment checks were undertaken prior to staff starting employment.

• One GP provided training on traveller culture forregistrars completing their education at the practice.

• A GP, nurse and some reception staff had undertaken additional training in relation to learning disabilities to enhance the care that this patient group received.

The areas where the provider must make improvements as they are in breach of regulations are:

• Safe care and treatment must be provided in a safe way to patients, including the proper and safe management of medicines and acting on all safety alerts.

• That systems and processes are established and operated effectively to ensure good governance. Including the documenting of assessing, monitoring and improving the quality of service provided.

The areas where the provider should make improvements are:

• The practice should review their complaints process to ensure patients are given information on how they can escalate the complaint if they remain dissatisfied.

• The practice should continue their work in improving the delivery of immunisations to children

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Chiddingfold Surgery is located in purpose built premises in a semi-rural location. It provides services to just over 4,500 registered patients. The practice dispenses prescriptions to approximately half of its patients.

We carried out a comprehensive inspection on 7 October 2014. We visited the practice location at Ridgley Road, Chiddingfold, Godalming, Surrey, GU8 4QP. Chiddingfold Surgery also operates a branch surgery at Dunsfold Surgery, 20 Griggs Meadow, Dunsfold, Surrey, GU8 4ND. We did not visit the branch surgery as part of our inspection.

We have rated the practice as outstanding. The inspection team spoke with staff and patients and reviewed policies and procedures implemented throughout the practice. Processes and procedures were in place to ensure the safety of patients and staff. The practice was responsive to the needs of the local population and engaged effectively with other services. There was a culture of openness, transparency, continual learning and improvement within the practice. The practice was committed to providing high quality patient care and provided good support and training to staff to facilitate this.

Our key findings were as follows:

• Thorough processes were in place to ensure safe dispensing of medicines to patients.
• Comprehensive assessment of risk ensured the safety of patients and staff.
• Detailed care planning and shared care protocols were in place to ensure the services met the needs of different population groups.
• The practice took a proactive approach to meeting the needs of different groups of patients and used innovative methods to engage with those in vulnerable circumstances.
• Patient feedback showed that patients felt they were involved in making decisions about their care and were treated with kindness and respect.
• Staff were well supported and continuous learning and improvement was encouraged

We saw several areas of outstanding practice including:

• Highly effective anticipatory care planning for patients with long term conditions.
• Innovative approaches to enable patients in vulnerable groups to access care services.
• The practice took a proactive approach to managing patient admissions to and discharge from hospital. 

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

The provider should:

• Improve the level of participation in the patient participation group to ensure the group reflects the practice population.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice