Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Townhill Medical Practice on 24 August 2016. Overall the practice is rated as requires improvement.

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, with the exception of those relating to training, recruitment checks and risk assessments.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure that an accurate, complete and contemporaneous record in respect of each patient is securely maintained.
• Ensure that training appropriate to job role is completed including safeguarding, Mental Capacity Act (2005), basic life support and fire safety.
• Ensure that all appropriate risk assessments are carried out.
• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure that blank prescription forms are stored and tracked within the practice in accordance with national guidance and practice protocol.
• Ensure that all practice specific policies and procedures are in place and up to date.

The areas where the provider should make improvement are:

• Develop and implement a system for recording when Deprivation of Liberty Safeguards are in place.
• Continue to monitor patient satisfaction scores particularly around telephone access to the surgery and nurse consultations.
• Continue to review processes to ensure patients with long term conditions receive the best care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Townhill Medical Practice in Caterham, Surrey on 24 August 2016 we found two breaches of regulation relating to the provision of safe and effective services. The overall rating for the practice was requires improvement. The concerns which led to these ratings applied to everyone using the practice and we rated all population groups as requires improvement. Specifically, the practice was rated requires improvement for the provision of safe and effective services. The practice was rated good for the provision of caring, responsive and well-led services. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Townhill Medical Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 20 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. Using information provided by the practice we found the practice was now meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. All six population groups have also been re-rated following these improvements and are also rated as good.

Our key findings were as follows:

• The practice was now ensuring all patient records were securely held. Electronic access to patient records was now available for all practice clinicians to use in the school and at the nursing homes which the practice provides GP services for.

• Training arrangements were consistent; there was now a system to identify when staff had training and when it would need to be refreshed. All staff had completed training appropriate to their job role. For example, all GPs had completed the correct level of safeguarding training appropriate to their job role.

• The practice was now operating safe systems in relation to health and safety. The practice had established and was now operating an effective system to assess, manage and mitigate the risks identified relating to the storage of liquid nitrogen.

• The practice had revised recruitment policies and processes which reflected national guidance. For example, supporting recruitment documentation which was missing during the August 2016 inspection had now all been recorded and documented correctly including evidence of full employment history for members of staff.

• Blank prescription forms and pads were kept securely and tracked through the practice.
• The practice had reviewed and updated the practice governance framework. This included a review of health and safety arrangements and supporting policies and procedures.
• Following the August 2016 inspection, the practice immediately developed and implemented a system for recording when Deprivation of Liberty Safeguards were in place. The Deprivation of Liberty Safeguards are an amendment to the Mental Capacity Act 2005. The Mental Capacity Act allows restraint and restrictions to be used – but only if they are in a person's best interests.
• Further steps had been taken to monitor patient satisfaction including a survey completed in February 2017. This survey involved the patient participation group (PPG) and specifically reviewed patient satisfaction regarding telephone access to the practice.
• Following a review of the management of diabetes within the practice population, improvements had been made including completed diabetic audits and the appointment of a special diabetes nurse. These actions had strengthened how the practice managed diabetes ensuring these patients received appropriate care and treatment.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice