Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Central Surgery on 31 August 2016. 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.
• The practice had policies in place to cover its activities; however, these were not always sufficiently prescriptive. For example, their recruitment policy did not provide details of when Disclosure and Barring Service (DBS) checks would be required, and the chaperone policy did not detail whether DBS checks should be carried-out on staff who acted as chaperones (however, all staff who acted as chaperones had received a DBS check).

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Feedback from patients about access to appointments was mixed, with some patients reporting that there was a lack of pre-bookable appointments. On the day of the inspection we saw evidence that there were sufficient appointments available; however, we did observe that in some cases patients had to wait a long time after their appointment time before they were seen. The practice had done some analysis of this and had identified the average waiting times for each member of clinical staff, and was addressing the issue with individuals.
• 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 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.

We saw one area of outstanding practice:

• The Advance Nurse Practitioner (ANP) was the lead nurse for the Kingston CCG Clinical Education Network and led on the professional development of nursing staff at the practice. She had researched and introduced the HeART online revalidation and appraisal tool for nurses, which allowed nursing staff to keep track of the training and education they had completed, complete a training needs analysis, and gather the necessary evidence for their appraisal and revalidation. This tool was piloted at the practice, and having found it a success, the ANP had presented this to the CCG and helped to roll-out the system to other practices across several neighbouring CCGs. She had also worked with a local further education college to introduce a Healthcare Assistant Diploma award.

The areas where the provider should make improvement are:

• Consider reviewing the appointment system to ensure that patients are not waiting too long to be seen once they arrive for their appointment.
• Ensure that the Patient Participation group is re-established in order to gather feedback and ideas from patients to improve patient experience.
• Review policies to ensure that they are practice-specific and contain sufficient detail.
• Consider establishing a failsafe process to check that results of cervical screening tests are received.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice