This practice is rated as Requires Improvement overall. (Previous rating December 2017 – Requires improvement)

The key questions at this inspection are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Seymour House Surgery - Hudson on 20 November 2018 to follow up on breaches of regulations identified during the previous inspection in December 2017.

At this inspection we found:

• There was a lack for formal processes in place to manage risk, and the management team did not have sufficient oversight of the risk mitigation activities undertaken by staff members. When incidents did happen, the practice learned from them and improved their processes; however, the records of these incidents did not contain sufficient detail about the actions taken and lessons learned, and information about incidents were not always shared in a timely way with relevant staff members.
• The governance framework in place was insufficient to ensure the safe and effective running of the practice, and leaders lacked insight about the consequences of this.
• 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.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

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

- Care and treatment must be provided in a safe way for service users.

- Systems or processes must be established and operated effectively.

The areas where the provider should make improvements are:

- Take action to increase the number of patients with caring responsibilities identified.

- Continue to take action to increase the uptake of childhood immunisations.

- Take action to increase the uptake of cervical screening.

- Review the results of the most recent NHS GP Patient Survey and take action to address areas of low patient satisfaction.

- Take action to establish a patient participation group.

I am placing this service in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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

Letter from the Chief Inspector of General Practice

This practice is rated as Requires improvement overall. (Previous comprehensive inspection October 2014 rated the practice as Good overall).

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? - Inadequate

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 – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

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

We carried out an announced comprehensive inspection at Seymour House Surgery on 5 December 2017 as part of our inspection programme.

At this inspection we found:

• The practice had some systems to manage risk, but these were not always applied consistently. When incidents did happen, the practice learned from them and improved their processes; however, the practice did not always keep complete and contemporaneous records of the action that had been taken.
• Overall, data collected and evidence viewed during the inspection showed that the practice provided effective care and treatment and achieved good clinical outcomes for patients; however, the practice’s uptake for childhood immunisations and cervical screening were below target. We saw evidence that care and treatment was delivered according to evidence- based guidelines; however, the practice did little to assure itself that this was the case.
• 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.
• There was a lack of governance arrangements to ensure that risk was managed and that quality assurance processes were in place which led to improvements in patient outcomes.

The areas where the provider must make improvements are:

• The practice must ensure systems and processes are established and operated effectively to demonstrate good governance.
• The practice must put processes in place to ensure that care and treatment is provided in a safe way for service users.

In addition, the provider should:

• Take action to increase the number of carers identified, in order that they can provide support to these patients.
• Take action to increase the uptake of childhood immunisations and cervical screening.
• Share details of all complaints and significant events with all members of staff.
• Introduce a process to comprehensively record the cleaning tasks undertaken by the cleaner.
• Consider introducing quality control processes in relation to patient consultations, prescribing decisions and clinical judgement decisions.
• Review the information available to patients about making a complaint to ensure that it is clear and accurate.

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 the practice on 28 October 2014. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches of regulations 12(f) and (g), 12 (2) (h), 15(2) and 19 (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We undertook this focussed inspection on 9 October 2015 to check that they had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Seymour House Surgery - Hudson on our website at www.cqc.org.uk.

Overall the practice is rated as Good. Specifically, following the focussed inspection we found the practice to be good for providing safe services. As the practice was now found to be providing good services for safe, this affected the ratings for the population groups we inspect against. Therefore, 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 make them vulnerable and people experiencing poor mental health (including people with dementia).

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

• a fire risk assessment as carried out on 28 January 2015 which identified a number of areas to be addressed which have been actioned or are in progress;
• the fire alarm is tested weekly;
• portable electrical appliances have been tested;
• a detailed cleaning schedule has been developed;
• the practice manager carries out regular checks of the standard of cleaning;
• the cleaner has completed training in infection control;
• improvements have been made to staff recruitment practices and for newly appointed staff the required checks were completed before they started;
• systems have been put in place to audit medicines every month and one of the GPs checks these audits.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Seymour House Surgery provides a GP service to just over 13,630 patients in Richmond. We carried out an announced comprehensive inspection at Seymour House Surgery on 28 October 2014. The provider has a branch surgery, Lock Road Surgery which was not inspected as part of this visit. The inspection took place over one day by a lead inspector, a GP specialist advisor and a practice manager specialist advisor.

Overall the practice is rated as Good. Specifically, we found the practice required improvement for providing safe services. It was rated good for all population groups. It was rated good for providing effective, caring, responsive and well led services.

Our key findings were as follows:

• Staff understood and followed policies and protocols to raise concerns, report incidents and these were recorded and investigated with actions shared to minimise the risk of similar occurrences in the future.
• Risks to patients were assessed but not always well managed, particularly regarding health and safety around the building, infection control, recruitment checks and equipment maintenance and checks.
• Data showed outcomes for patients were average for the area. Audits were completed.
• Patients said they were treated with respect, their privacy was maintained and they were involved in decisions about their care and treatment.
• There was a range of in advance and on the day appointments with telephone consultations and home visits provided when required, however some patients said they experienced difficulties getting appointments, particularly with their GP of choice.
• Polices were in place and kept under review
• Systems were in place to seek feedback from patients and staff.

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

Importantly, the provider must:

• Ensure medicines and prescriptions are stored securely and systems to check expiry dates are robust;
• Ensure action is taken to address all identified concerns with Healthcare associated infection prevention and control practice;
• Ensure a fire risk assessment is carried out and the fire alarm is tested weekly;
• Ensure all portable electrical appliances are tested regularly;
• Ensure staff recruitment processes include the required checks being completed before staff start work

In addition the provider should:

• Improve systems to check sufficient supplies of personal protective equipment and general items at the practice;
• Ensure patient confidentiality is maintained at all times especially as regards the location where patients leave samples;
• Improve storage to ensure all patient records and cleaning materials are stored securely.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice