Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr P Kumar & Partners (also known as Chessington Park Surgery) on 27 May 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services to Older people, Working age people (including those recently retired and students), Families, children and young people, People whose circumstances may make them vulnerable, and People experiencing poor mental health (including people with dementia). Chessington Park Surgery is rated as outstanding for the care of people with long term conditions.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.

We saw the following areas of outstanding practice:

• The practice provided a range of additional services and support in-house to people with long term conditions including diabetic retinal screening, dietician, podiatry and an expert patient programme. A care coordinator was in post to coordinate the care of patients with long term conditions.

• The practice proactively sought and built relationships with other local providers for the benefit of their patients. They hosted various organisations in their practice premises including the local carers’ network on a fortnightly basis, and a six session community based programme for people with long term conditions, called expert patient programme. The expert patient programme had been completed by three patients from Chessington park surgery during April 2015.

• In November 2014, the practice used a secret shopper service to assess the effectiveness of their chlamydia screening programme. They used the feedback of the ‘shopper’s’ experience to plan improvements which included briefing to the reception team by the practice nurse, who had specialist training in sexual health; and provided a separate area that the reception staff could take patients to discuss private matters.

• The practice arranged for students from a local learning disabilities school to visit the practice over a lunchtime period when they when they were quiet, to spend time with the staff team, learn more about what they do, and to help reduce any fears they may have about visiting their doctor surgery. The session was well received by the teachers and students.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Requires improvement overall. (Previous inspection May 2015 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires Improvement

We carried out an announced comprehensive inspection at Dr P Kumar and Partners (also known as Chessington Park Surgery) on 22 May 2018 as part of our inspection programme.

At this inspection we found:

• Overall, 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, there were some areas which required review to ensure that processes were safe and effective; for example, the practice did not keep a log of their use of prescription stationery, and there was no process in place to ensure that safety and medicines alerts were acted on.
• The practice conducted reviews of the effectiveness and appropriateness of the care it provided when this was required by the Clinical Commissioning Group (CCG). It had processes in place to ensure that the care of patients with long-term conditions was regularly monitored; however, we saw evidence that the care of patients with learning disabilities and those with dementia was not always reviewed and documented in sufficient detail.
• The practice had failed to ensure that nursing staff received a regular appraisal, and there was no process in place to monitor the clinical decision making of clinical staff, including non-medical prescribers.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice had a culture of aspiring to provide high-quality sustainable care and to continuously improve; however, in some areas there were insufficient arrangements in place to ensure that processes were effective.

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

• Ensure persons employed by the service provider in the provision of a regulated activity receive such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform.
• Ensure that they maintain securely an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided to the service user and of decisions taken in relation to the care and treatment provided.
• Ensure that care and treatment is provided in a safe way for service users.

The areas where the provider should make improvements are:

• Assess the arrangements in place in respect of the security of prescription stationery, taking into account best practice guidance, and make any necessary changes.
• Consider putting arrangements in place to monitor that the process for seeking consent from patients prior to receiving treatment is consistently and appropriately applied.
• Putting in place tools to assist staff in communicating with people with learning disabilities, in particular, to enable staff to assess the level of pain being experience by these patients.
• Consider introducing a programme of audit specific to the services provided.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice