We carried out an announced focused inspection at Oxted Health Centre on 28 March 2019 as part of our inspection programme.

At the last inspection in April 2018 we rated the practice as requires improvement for providing safe services because:

• Patient Group Directions, adopted by the practice to allow nurses to administer medicines in line with legislation, were not always completed correctly.
• Significant events and external safety alerts were not always thoroughly recorded, investigated and acted upon.

We also found areas where the provider should make improvements:

• Review and improve recording practices for documenting reasons for rejected prescription requests.
• Review and strengthen the methods for receiving and acting on staff feedback.

At this inspection, we found that the provider had satisfactorily addressed all of these areas.

We based our judgement of the quality of care at this service is 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.

Overall the practice continues to be rated as good and is now good in the safe domain.

Details of our findings

At this inspection we found:

• The practice had systems to make sure staff had appropriate authorisation to administer medicines. All patient group directions had been completed correctly and in line with legislation.
• There were processes to identify, understand, monitor and address current and future risks including risks to patient safety. The practice fully recorded, investigated and acted on significant events and safety alerts. Actions were taken to improve safety and lessons were learned.
• The practice was fully aware of prescription issues, including that they kept up to date with local changes that affected the practice. They were clearly recording reasons for rejected prescriptions.
• Staff felt supported by the practice and they were encouraged to speak up about concerns or suggest ideas for improvement. They were happy with the level of communication at the practice and said it was an open and friendly culture.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

This practice is rated as Good overall. (Previous inspection 15 December 2015 – Good)

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 Oxted Health Centre on 24 April 2018. We carried out this inspection 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:

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There were processes to identify, understand, monitor and address current and future risks including risks to patient safety. However, some of these processes were not always implemented effectively, including the recording and oversight of safety alerts, significant events and completion of patient group directions
• 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. This included staff that had specialist skills and experience.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. 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 was co-located with a range of additional healthcare services and worked in collaboration with local and national schemes.
• 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.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Review and improve recording practices for documenting reasons for rejected prescription requests.
• Review and strengthen the methods for receiving and acting on staff feedback.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Oxted Health Centre on 15 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 said they found it easy to make an appointment with GP. 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.

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

The provider should:

• Ensure that the practice's recruitment policy is amended to reflect that all staff must have satisfactory checks in place to ensure their suitability to carry out their role prior to working unsupervised with patients. This must include a check via the Disclosure and Barring Service.
• Ensure the infection control audit is completed to identify outcomes and actions required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an inspection at Oxted Health Centre to tell us about the care and treatment the staff gave to its patients as well as what other services were available. As part of our inspection we observed the way staff spoke with patients, spoke to five members of staff, one GP, three community nurses and five patients.

Patients told us they felt respected by staff. We were told “Yes, they are very nice” and “Everyone is lovely.”

Patient’s told us that they felt they were given enough information about their care and treatment and were able to ask questions. One patient said “I ask as many questions as I like” and another told us “”I feel I have time to ask questions.”

Patients told us they felt safe with the staff at the practice, however we noted that not all clinical staff had received training in safeguarding vulnerable adults or child protection and not all staff were aware of the reporting procedures if they had a safeguarding concern.

Some staff told us they felt frustrated at the lack of support they received and that they were not always encouraged to develop professionally.

We found that the waiting room did not display information to patients on how to make a complaint. However none of the patients we spoke with on the day told us they had needed to make a complaint.