Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eagle House Surgery on 23 June 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 was in place for reporting,recording and learning from significant events.
• Risks to patients were assessed and well managed.
• 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.
• 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 found one area of outstanding practice:

One of the partners at the practice developed a suspected cancer referral form based on NICE guidance. GPs in all CCGs in the London area are advised to use these forms when referring patients with a suspected cancer. The form is available on four clinical systems and on the NHS Healthy London Partnership website.

The areas where the provider should make improvement are:

• To review thesystem for uncollected prescriptions ensuring oversight by a clinician.

• Review how patients with caring responsibilities are identified and recorded on the patient record system to ensure information, advice and support is made available to them.

• To review the systems in place for managing long term conditions with a view to improving outcomes for patients with hypertension.

• Review and improve patient satisfaction scores in relation to access to the service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This visit was a follow up to our inspection of the practice on 14 January 2014.

We had seen that the cleaning schedule for the premises did not detail the procedure for high, medium or low risk areas. It also did not include equipment needed for each task nor specify the products to be used. There was no member of staff designated as the infection prevention and control (IPC) lead. This meant that roles and responsibilities were unclear in relation to IPC.

Following our inspection in January, the provider sent us a plan of the actions intended to meet the requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We carried out this visit to check that the actions in that plan had been implemented.

We found that the provider had taken appropriate action and was now compliant with the regulations.

We spoke with six patients attending appointments at the surgery on the day of our visit. Everyone told us their privacy and dignity had been respected by staff. All consultations took place in a room with the door closed and curtains were pulled around the examining couch before patients were examined.

Patients expressed their views and were involved in making decisions about their care and treatment. The surgery had a well-established patient participation group (PPG) formed of patients registered at the practice. The surgery took time to capture patient feedback. Patients were happy with the service they received. One patient commented "the staff are amazing they make you feel special." Another said "I am content with the services that have been provided at the surgery."

Patients’ needs were assessed and care and treatment planned and delivered in line with their individual plan of care. Patients were referred to an appropriate service if diagnostic tests were required. Processes were in place to ensure the timely review of patients with long-term conditions at specified intervals.

Patients we spoke with were happy about the care and treatment they had received at the surgery. We saw staff interacting with patients in a caring and sensitive way and responding appropriately to their questions in the reception area and or on the telephone. A patient told us during their appointment they appreciated that a GP “always takes whatever time is needed with me, I don't feel rushed to finish what I am saying."

There were arrangements in place to deal with foreseeable emergencies. Staff we spoke with knew what to do in the event of an emergency. Equipment and emergency medication were monitored regularly and staff had been appropriately trained.

Patients were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. All patients we spoke with said they felt safe under the care of clinicians at the surgery. One patient said "I know my safety is important to the doctors here. If I feel vulnerable I feel able to express myself."

Patients we spoke with on the day of our visit felt that the surgery was generally clean. For example, one patient described the surgery as "clean and looked after, and generally pleasant." The surgery was cleaned regularly by outside contractors. We saw that cleaning schedules and frequencies were displayed for cleaning staff to follow. However, the cleaning schedule did not detail the cleaning procedure for high, medium or low risk areas. It also did not include equipment requested for each task nor the products used.

Patients were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There was no designated person in the surgery as the infection prevention and control (IPC) lead. This meant that roles and responsibilities were unclear in relation to IPC.