Letter from the Chief Inspector of General Practice

Heathcote Medical Centre was previously inspected in December 2015 and was rated good in all domains and overall.

At this inspection in January 2018 the practice is rated as Good in all domains and overall.

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

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 Heathcote Medical Centre on 17 January 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The practice had clear systems to manage risk, including risk assessments, 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Staff were supported in personal development and training and received regular appraisal.
• The practice had accessible facilities and was equipped to treat patients and meet their needs.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. However, the patient survey showed lower than average results for the question ‘how easy is it to get through to someone at your GP surgery on the phone’. We explored this with the surgery and found that the surgery was putting measures in place to improve patient satisfaction.
• The practice ensured patients had good access to care by offering extended hours surgeries, and telephone consultations, as well as offering appointment booking on the practice website.
• The practice had several GPs who were on maternity leave and to provide continuity of care they had employed long term locums to cover their patients.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Consider ways to identify and support more patients who are carers.
• Continue to review ways to improve patient satisfaction when contacting the practice.
• Consider ways to identify when risk assessments are due.
• Review the recording of information for those patients requiring additional care by using registers and centrally recording information.

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 Heathcote Medical Centre on 8 December 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 we spoke with and most comment card responses said they found it easy to make an appointment with GP. Two of fifteen comment cards indicated there were difficulties with getting appointments. All feedback was positive in respect of 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.

There were areas that the provider should make improvements :

The provider should:

• Ensure chairs identified as not suitable for clinical areas are removed and replaced.
• Ensure plans to undertake an updated infection control audit are completed.
• Ensure the changes to improve the patient experience of reception and appointment booking are kept under review.
• Ensure a record of nurse team meetings and discussions is maintained to assist with training and development.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Heathcote Medical Centre is located in purpose built premises in a semi-rural location. The practice provides services to approximately 12,200 registered patients.

We carried out a comprehensive inspection on 11 November 2014. We visited the practice location at, Heathcote, Tadworth, Surrey, KT20 5TH.

We have rated the practice as requires improvement. 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.

Our key findings were as follows:

• Staff were well supported and continuous learning and improvement was encouraged. However, some areas of mandatory training were not up to date.
• Effective communication and information sharing was evident both within the practice staff team and with external services.
• GPs holding lead roles in the management of long term conditions such as diabetes and mental health promoted the use of best practice in order to continually improve the care of patients.
• All patients had a named GP and GPs managed their own personalised lists.
• Patients reported experiencing difficulty in accessing the practice by telephone to make appointments or to speak with staff.
• Patients also reported considerable delays in accessing appointments with their named GP.
• Some patients found reception staff to be unhelpful.
• The practice had taken steps to respond to patient feedback but some of the difficulties experienced by patients remained unresolved.

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

Importantly, the provider must:

• Ensure all staff receive up to date training in mandatory areas such as fire safety and basic life support.
• Ensure risk assessment and monitoring processes effectively identify, assess and manage risks relating to the health, safety and welfare of patients and staff.
• Ensure criminal record checks are undertaken via the Disclosure and Barring Service for nurses and 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:

• Continue to review and improve telephone access to the practice for patients.
• Review and improve access to routine appointments with a named GP.
• Ensure electrical equipment is regularly examined and where required, safety testing is undertaken.
• Ensure staff appraisals include documented input from the appraiser.
• Promote the availability of the chaperone service within consulting rooms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice