Letter from the Chief Inspector of General Practice

Following a previous comprehensive inspection of Manor Practice on 6 January 2015 the practice was given an overall rating of requires improvement. Requirement notices were set for regulations 9 (care and welfare of people who use services) and 21 (requirements relating to workers) of the Health and Social Care Act 2008.

Subsequent to the 6 January 2015 inspection we carried out an announced comprehensive inspection at Manor Practice on 27 April 2017. The practice had addressed the requirements arising from the earlier inspection and overall the practice is now rated as good.

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

• Previous breaches of regulation in respect of recruitment checks had been addressed by the practice - all staff who acted as chaperones were trained for the role and had received a Disclosure and Barring Service (DBS) check in accordance with practice policy.
• Previous breaches in regulation in respect of patient specific directions (PSDs) had been addressed – PSDs were now in place for healthcare assistants to administer vaccines, and for the nurses to administer certain medicines such as birth control injections.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• 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.
• 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 provider had responded to failings identified at the previous CQC inspection by appointing an experienced practice manager, committing to more clinical and financial investment from the partners, and the development of a comprehensive business development plan with input from the whole staff team.

The areas where the provider should make improvements are:

• Ensure that systems are in place to check the expiry dates of disposable equipment.
• Continue to monitor and take action to improve patient satisfaction with the practice opening hours.
• Install hearing loops in the reception areas at both sites.

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 Manor Practice on 06 January 2015. We visited the main practice site at 57 Manor Road Wallington Surrey SM6 0DE. The practice has a branch surgery at Roundshaw Health Centre 6 Mollison Square Wallington SM6 9DW. We did not visit the branch surgery as part of this inspection.

Overall the practice is rated as requires improvement. Specifically, we found the practice requires improvement for providing safe and effective services. We found the practice was good for providing caring and responsive services, and that it was well led. We found the practice required improvement for providing services to the six population groups we report on.

Our key findings were as follows:

• The practice used the Quality and Outcomes framework to measure, monitor and improve performance; and was performing better when compared to other practices in the area and against national averages.
• The practice was responsive to people’s needs, including those of various groups of people in vulnerable circumstances
• The practice was well led, and was a teaching practice
• Patient feedback indicated that people experienced a caring service and that they were treated with respect and dignity

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

Importantly, the provider must:

• Have in place patient specific directions (PSDs) for the healthcare assistant to administer vaccines and for the nurses to administer certain medicines such as birth control injections, in line with legal requirements and national guidance.

• Ensure a suitable policy and procedure is in place in relation to the completion of disclosure and barring service checks for new staff.

• Ensure audits of practice are undertaken, including completed clinical audit cycles.

In addition the provider should:

• Ensure medicines requiring old storage are appropriately stored in fridges

• Ensure the safeguarding policy is reviewed and dated.

• Ensure an automated external defibrillator (AED) is available, or have on record a risk assessment if a decision is made to not have an AED on-site.

• Ensure staff are up to date with fire safety training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice