Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Guildford Rivers Practice on 29 October 2014. The practice was found to require improvement for providing safe, effective and well led services. The practice was also found to require improvement in providing services for people with long-term conditions and people whose circumstances may make them vulnerable.

Following the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the regulations in relation to the following:

• Ensure consistent arrangements to provide support to staff by means of appropriate supervision, appraisal and professional development.
• Introduce a process of audit of infection control processes.
• Ensure recruitment processes include all required pre-employment checks in order to minimise the risks to the health, safety and welfare of patients.
• Ensure risk assessment and monitoring processes effectively identify, assess and manage risks relating to the health, safety and welfare of patients and staff.

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

• Seek to gather feedback from patients via patient surveys and the establishment of a patient participation group.
• Establish a process to ensure more formal sharing of information and encourage continuous learning and improvement of all staff.
• Identify and monitor the risks associated with the role of the outreach nurse in visiting vulnerable patients within their own homes.
• Ensure a consistent approach to the use of alerts on the practice’s electronic records system in order to highlight vulnerable children and adults.
• Develop a practice website to improve patient access to information relating to the practice and facilitate on line appointment bookings.

We undertook this focused inspection on 13 August 2015 to check that the provider had followed their action plan and to confirm that they now met the regulations. At this inspection we found the practice was good for providing safe, effective and well led services. The practice was also good for providing services for people with long-term conditions and people whose circumstances may make them vulnerable.

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

• The practice had developed processes to ensure all staff received an appraisal and were supported by a personal development plan.
• Training was planned to support individual learning needs and promote professional development.
• A series of regular meetings and training events within the practice encouraged sharing of information and continuous improvement.
• Recruitment processes included all required pre-employment checks to minimise the risks relating to the health, safety and welfare of patients.

• The practice had undertaken an audit of infection control processes.
• Risk assessment and monitoring processes had been implemented in areas such as fire safety, legionella, infection control and the role of the outreach nurse.
• The practice had reviewed its use of alerts to ensure these were used consistently to highlight vulnerable children and adults.
• The practice had established a patient participation group (PPG) and was planning to undertake a patient survey.
• The practice had reviewed the content of its patient information leaflet to improve information available to patients.
• Access to online appointment bookings and repeat prescription requests were available via the practice’s NHS Choices website.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of The Guildford Rivers practice on 29 October 2014. We visited the practice location at Hurst Farm Surgery, Chapel Lane, Milford, Surrey GU8 5HU.

We have rated the practice as requires improvement. Although some aspects of the practice were good, areas of improvement were required. The inspection team spoke with staff and patients and reviewed policies and procedures implemented throughout the practice. The practice was responsive to the needs of the local population and engaged effectively with other services.

Our key findings were as follows:

• There was a range of appointments to suit most patients’ needs. Patients reported good access to the practice and a named GP or GP of choice, with urgent appointments available the same day.
• The practice engaged effectively with other services to ensure continuity of care for patients.
• Patient feedback showed that patients felt they were involved in making decisions about their care and were treated with kindness and respect.
• The practice had implemented an innovative approach to meeting the needs of vulnerable patients by developing an ‘outreach nurse’ role to visit those patients in their own homes and to coordinate all aspects of their care and support. However, risks associated with this role had not been fully assessed by the practice.

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

Importantly, the provider must:

• Ensure consistent arrangements to provide support to staff by means of appropriate supervision, appraisal and professional development.
• Introduce a process of audit of infection control processes.
• Ensure recruitment processes include all required pre-employment checks in order to minimise the risks to the health, safety and welfare of patients.
• Ensure risk assessment and monitoring processes effectively identify, assess and manage risks relating to the health, safety and welfare of patients and staff.

The provider should:

• Seek to gather feedback from patients via patient surveys and the establishment of a patient participation group.
• Establish a process to ensure more formal sharing of information and encourage continuous learning and improvement of all staff.
• Identify and monitor the risks associated with the role of the outreach nurse in visiting vulnerable patients within their own homes.
• Ensure a consistent approach to the use of alerts on the practice’s electronic records system in order to highlight vulnerable children and adults.

• Develop a practice website to improve patient access to information relating to the practice and facilitate on line appointment bookings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice