Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 4 February 2015. Breaches of legal requirements were found during that inspection within the safe, effective and well-led domains. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:

• Ensure that all staff are trained in the safeguarding of children and vulnerable adults.

• Ensure all staff are supported by means of receiving appraisals

• Ensure a programme of infection control processes is in place in order to ensure that policies and processes are effectively implemented.

• Ensure that risk assessment and monitoring processes effectively identify, assess and manage risks relating to health, safety and welfare of patients and staff

  Our previous report also highlighted areas where the practice should improve:-

• Establish a process to ensure more formal sharing of information and learning from incidents for all staff

We undertook this focused inspection on 24 November 2015 to check that the provider had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

This report should be read in conjunction with the last report from February 2015. Our key findings across the areas we inspected were as follows:-

• All staff had completed vulnerable adult and child safeguarding training to the appropriate level for their role and responsibilities.

• All staff had had a documented appraisal and were aware when the next was due.Training needs and opportunities were identified and acted upon.

• An infection control audit had been carried out and acted upon. The due date for the annual review of the audit was entered into the practice manager and infection control lead’s calendars and would trigger an alert.

• A risk assessment had been carried out in relation to fire safety

• A new system for recording significant events that identified a wider range of risk had been devised and was available on the computer hard drive.

• Significant events meetings were held every four to six weeks, decisions and learning were minuted, documented and disseminated to appropriate staff via their leads and via staff meetings.

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 Chapel Street Surgery on 4 February 2015. We visited the practice location at Chapel Street, Newhaven, East Sussex, BN9 9PW.

Overall the practice is rated as requires improvement. Specifically, we found the practice to be good for providing caring and responsive services. It required improvement for providing safe, effective and well led services. It also required improvement 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. 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.
• The practice understood the needs of the local population and planned services to meet those needs.
• The practice worked closely with external agencies and community services to meet the needs of patients and ensure continuity of care.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients and staff were not always assessed and well managed.
• Staff had generally received training appropriate to their roles and any further training needs had been identified and planned. However, some staff had not received training in the safeguarding of children and vulnerable adults.
• 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.

However, 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 children and vulnerable adults.
• Ensure all staff are supported by means of receiving appraisals.
• Ensure a programme of audit of infection control processes is in place in order to ensure that policies and processes are effectively implemented.
• Ensure risk assessment and monitoring processes effectively identify, assess and manage risks relating to the health, safety and welfare of patients and staff.

In addition the provider should:

• Establish a process to ensure more formal sharing of information and learning from incidents for all staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We used a number of different methods to help us understand the experiences of people who used the service. We talked with six people who used the service, one of who was also a member of the practices Patient Participation Group (PPG). We observed interaction between staff and people who used the service. We reviewed records and systems and looked at the environment and how this impacted on the service delivery. We spoke with staff that included; the practice manager, the deputy practice manager, a nurse practitioner, a healthcare assistant, and two receptionists. We also spoke with two GP’s in the partnership one of who was also the registered manager for the practice.

This told us that people who used the service care needs had been assessed; they had time to discuss their health care issues, and had been fully involved in making decisions about their care and treatment. Comments from people who used the service included, "I have always been quite happy. I have always felt quite safe. I do not feel I have ever had a problem in all the years I have been here,” “I feel very happy that Newhaven has such a good service here. Such a considerate service to care for us. I can’t sing their praises enough,” and “I feel really comfortable here. They are really welcoming.”

We saw that processes were established that ensured staff had an understanding of abuse and what to do if it was suspected.

People were protected from the risk of infection because appropriate guidance had been

followed.

Recruitment procedures were in place to protect people who used the service.

There was an annual patient survey carried out with the PPG and there were arrangements for the practice to monitor standards of quality and safety.