Letter from the Chief Inspector of General Practice

On 14 May 2015 we carried out a comprehensive inspection of The Orsett Surgery. They were rated as good overall. They were rated as requires improvement for providing safe services and good for providing effective, caring responsive and well-led services. As a result of this inspection the practice were issued with a requirement notice for improvement.

The issues we identified were as follows;

• Staff were not clear about safeguarding procedures.

• Staff trained as chaperones were unclear about their role. Some staff had not received DBS checks and a risk assessment was not in place as to why they were not necessary.

• Procedures in place to manage medicines, including controlled drugs in use at the practice were not effective. Staff undertaking dispensing duties had not received sufficient training or supervision. Written procedures for the dispensing of medicines were incomplete. Prescription stationery was not being monitored.

• Infection control procedures required improving in relation to monitoring the quality of the cleaning and carrying out audits.

• The fire risk assessment required more detail to manage the risk of combustible cleaning material.

• There was no hearing loop to support patients with impaired hearing, no call bell in the toilet facilities for patients who might need assistance and access to the premises was difficult for patients with limited mobility.

After the inspection the practice sent us an action plan that identified the improvements they intended to make and when they would be completed.

We then visited the practice on 05 February 2016 to review the improvements made by the practice. We found that the practice had made all of the improvements required and had complied fully with the requirement notice.

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 The Orsett Surgery on 14 May 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing effective, caring, responsive services and well led. It was also good for providing services for older people, people with long term conditions, families, children and young people, working aged people (including those recently retired and students), and people with mental health (including people with dementia). The practice required improvement for providing safe services.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses within the practice. Improvements were needed to ensure that staff were aware of procedures for raising and reporting concerns to external agencies including local the safeguarding team.
• Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Improvements were needed to ensure that risks to patients and staff were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Patients said they were treated with empathy, compassion, dignity and respect and they were listened to and involved in making decisions about their care and treatment.
• Information about services and how to complain was available and easy to understand. Complaints were investigated and responded to in a timely and appropriate way.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. Referrals to secondary care services were made appropriately and in a timely manner in line with local and national guidance and targets.
• The practice had good facilities and was well equipped to treat patients and meet their needs. However improvements were needed to ensure that services were accessible and suitable for patients with mobility or other physical disabilities or impairments.
• 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.

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

Importantly the provider MUST:

• Ensure that patients are protected against the risks of unsafe care by the safe management of medicines and ensuring that staff receive appropriate training and follow appropriate guidance, policies and procedures.

The provider also SHOULD:

• Ensure that all staff who undertake chaperone duties are aware of their roles and responsibilities and are subject to risk assessments and /or security checks.
• Ensure that staff are aware of how and when to report safeguarding concerns to external agencies.
• Ensure that detailed records are maintained in respect of cleaning carried out and audits are carried out to test the effectiveness of infection control procedures.
• Review the arrangements for promoting access and assistance for patients with mobility or other physical disabilities.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We conducted this inspection to follow up on compliance actions following our last inspection on 20 November 2013 when we found concerns regarding the secure storage of confidential information which related to people who used the surgery.

These concerns related to paper medical records which were not stored securely and confidential information which was not stored securely before it was shredded.

During our inspection on 05 March 2014 we found that improvements had been made.

We observed that keypad locks had been installed to secure the rooms where confidential information regarding the people who used the service was kept. During our inspection we saw that these were being used appropriately by staff.

We spoke with four members of staff all of whom confirmed that the keypad locks were used. One member of staff told us, “It safeguards us, patients' notes and things that are confidential.”

This demonstrated that medical records and confidential information which related to people who used the surgery were kept securely.

We spoke with five people who used the surgery. One person said, “I like it. It is old fashioned. You still get the personal touch.” Another person told us, “People are names not numbers.”

People said that their privacy was maintained, they were treated with dignity and were involved in their care. One person told us, “They always maintain my privacy.” Another person said, “I would be involved it would be a joint decision.” We looked at the medical records of five people who used the service and found that people experienced care and treatment that met their needs and protected their rights.

We saw that staff were able to identify the possibility of abuse and respond appropriately. One clinician told us, “If I was concerned I would go to social services duty team and ask for help.”

The surgery held regular staff meetings and we saw evidence of staff training and appraisals. One member of staff told us, “It is very busy. I am supported to do my job.” Another member of staff told us, “I feel fully supported in my training requirements by the practice.”

We saw that staff had clear guidance in relation to information governance and that this was followed in their day to day work. One member of staff told us, “We are given information when we start and we have reminders about confidentiality at our meetings.”

We found that not all medical records were stored securely.

We reviewed the information available to us about The Orsett Surgery on 8 May 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.