Letter from the Chief Inspector of General Practice

The practice was rated good overall and is now rated good for providing safe services.

We carried out an announced comprehensive inspection of this practice on 5 November 2015. A breach of legal requirements was found during that inspection within the safe domain. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the legal requirements. We conducted a focused inspection on 23 November 2016 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.

During our previous inspection on 5 November 2015 we found the following areas where the practice must improve:

• Ensure that action is taken as a result of the Legionella risk assessment.

• Ensure that disposable curtains are replaced in line with infection control guidance.

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

• Ensure that all clinical audits are full cycle and clearly demonstrate improvements have been made as a result.

• Ensure there is a consistent approach to care planning for patients with long term conditions and that records of care plans are kept on file, as well as being handed to the patient.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

During the inspection on 23 November 2016 we found:

• All recommendations made in the Legionella risk assessment from May 2015 had been implemented and a further risk assessment dated 5 February 2016 showed that there were no outstanding risks.

• Disposable curtains in clinic rooms had been replaced, in accordance with infection control guidance and practice policy, every six months. There was a schedule in place for checking and recording this.

We also found in relation to the areas where the practice should improve:

• The practice had conducted second cycles of four clinical audits, which all showed that improvements had been made. The practice now had an on-going programme of clinical audit in place.

• There was a consistent approach to care planning for patients with long term conditions and records of care were kept on file, as well as being handed to the patient.

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 Woodingdean Surgery on 5 November 2015. Overall the practice is rated as good.

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 a legionella risk assessment where the subsequent action had not yet been carried out and where disposable curtains had not been replaced within the timeframe in which they were due.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had an active Patient Participation Group who worked with staff to review patient feedback and work on projects to improve the patient experience (e.g. improving the environment for patients with dementia and an age generation project aimed at bringing together people in the community).
• 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.
• 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 action is taken as a result of the legionella risk assessment.
• Ensure that disposable curtains are replaced in line with infection control guidance.

The areas where the provider Should make improvement are:

• Ensure that all clinical audits are full cycle and clearly demonstrate improvements are made as a result.
• Ensure there is a consistent approach to care planning for patients with long term conditions and that records of care plans are kept on file, as well as being handed to the patient.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice