Letter from the Chief Inspector of General Practice

Enys Road Surgery was previously inspected in August 2015 and was rated good in all domains and overall.

At this inspection in December 2017 the practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

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

We carried out an announced comprehensive inspection at Enys Road Surgery on 18 December 2017 as part of our inspection programme.

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.

• The practice operated a ‘traffic light’ system for patients who were high risk and needed a prompt response if they requested help.

• They practice offered an afternoon walk-in service for registered patients with urgent concerns.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• The practice encouraged patient feedback and responded positively to patient needs.

• There was a strong focus on continuous learning and improvement at all levels of the organisation. The practice taught external practitioners from several clinical disciplines and encouraged learning and improvement within their own staff.

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

Establish effective systems and processes to ensure that care and treatment is provided in a safe way for service users. By:-

• Ensuring that the fire risk assessment is updated and all actions taken recorded.

• Ensuring all outstanding electrical work is completed.

The areas where the provider should make improvements are:

• Review how GP registration is recorded and monitored on an ongoing basis.

• Consider having a GP check prescriptions issued, but not picked up by patients before destroying them.

• To adhere to the recruitment policy on all occasions.

• Review the low uptake of pneumococcal booster vaccine for children aged two.

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 2 December 2014.

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

• The practice must ensure that all staff are trained in safeguarding of vulnerable adults.
• The practice must ensure staff have appropriate policies and procedures for safeguarding vulnerable adults.
• The practice must ensure criminal record checks are undertaken via the Disclosure and Barring Service for staff trained to provide chaperone services.
• The practice must ensure all remedial works and on-going monitoring recommendations are implemented in order to reduce the risk of exposure of staff and patients to legionella bacteria.

We undertook this focused inspection on 18 August 2015 to check that the provider had implemented 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:-

• The practice had ensured that all staff were trained in safeguarding of vulnerable adults and we saw training certificates for staff which confirmed this to be the case. We saw that the practice manager was monitoring time frames for training and had maintained a comprehensive training record for all staff.
• The practice had ensured that staff had appropriate policies and procedures for safeguarding vulnerable adults. We viewed the policies and procedures and staff we spoke with demonstrated an understanding of how these were applied to their practice.
• The practice had ensured criminal record checks were undertaken via the Disclosure and Barring Service for staff trained to provide chaperone services. We viewed risk assessments and DBS records which confirmed this action had been carried out.
• The practice had ensured all remedial works had been carried out and that on-going monitoring recommendations were implemented in order to reduce the risk of exposure of staff and patients to legionella bacteria. We saw that action had been taken to implement a system of monitoring and that the works had been carried out.

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 Enys Road Surgery on 2 December 2014. We visited the practice location at 5-7 Enys Road, Eastbourne, BN21 2DQ.

Overall the practice is rated as good. Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It required improvement for providing safe services. It was also good for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

The inspection team spoke with staff and patients and reviewed policies and procedures. The practice understood the needs of the local population and engaged effectively with other services. There was a culture of openness and transparency within the practice and staff told us they felt supported. The practice was committed to providing high quality patient care and patients told us they felt the practice was caring and responsive to their needs.

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

• 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. However, staff had not always received training and guidance in the safeguarding of vulnerable adults.
• There was a culture of continuous learning and improvement within the practice.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• All patients had a named GP and GPs managed their own personalised lists.
• The practice engaged effectively with other services to ensure continuity of care for patients.

There were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that all staff are trained in safeguarding of vulnerable adults.
• Ensure staff have appropriate policies and procedures for safeguarding vulnerable adults.
• Ensure criminal record checks are undertaken via the Disclosure and Barring Service for staff trained to provide chaperone services.
• Ensure all remedial works and ongoing monitoring recommendations are implemented in order to reduce the risk of exposure of staff and patients to legionella bacteria.

In addition the provider should:

• Undertake risk assessment of nursing positions not subject to retrospective criminal records checks via the Disclosure and Barring Service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating February 2018 – Good)

The key questions at this inspection 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 Enys Road Surgery on 18 December 2017. The overall rating for the practice was good. The practice was also rated good for the effective, caring, responsive and well-led domains and all the population groups. It was however rated as requires improvement for providing safe services. The full comprehensive report on the December 2017 inspection can be found by selecting the ‘all reports’ link for Enys Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 June 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 18 December 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

At our inspection of 18 December 2017, we found that:

The fire risk assessment needed to be updated and all actions taken recorded

An electrical safety risk assessment had been carried out in January 2016 but actions required had not been completed.

At this inspection our key findings were as follows:

A new fire risk assessment had been carried out and actions completed.

All outstanding electrical work had been completed.

Additionally we saw that:

There was now a system for reviewing and monitoring the registration status of all clinical staff on an ongoing basis.

There was a system in place that ensured that a GP checked all prescriptions that had been issued but not picked up before they were destroyed.

The practice was adhering to their recruitment policy.

The practice had reviewed the uptake of pneumococcal vaccine of children aged 2 years and the most recent figures we were shown exceeded the national 90% target.

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

Please refer to the detailed report and the evidence tables for further information.