Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 16 October 2014. Breaches of legal requirements were found during that inspection within the effective domain. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the legal requirements in relation to the following:

• The practice must ensure that the practice's mandatory training for staff is completed and monitored to ensure that time frames for renewal do not lapse. This includes ensuring staff have completed relevant training for safeguarding children and vulnerable adults.

We undertook this focused inspection on 10 August 2015 to check that the provider had implemented their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

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

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

• The practice had ensured that all staff were up to date with the practice's mandatory training and we saw training certificates for staff which confirmed this to be the case. We saw that the practice manager was monitoring time frames for training and had maintained a comprehensive training record for all staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

East Horsley Medical Centre was inspected on the 16 October 2014 as a comprehensive inspection.

We have rated the practice as good. The inspection team spoke with staff and patients and reviewed policies and procedures which were in date and relevant. Patient care was reviewed and care plans were in place for patients with complex needs. We noted meetings with other services were in place and the practice shared relevant information with other services in order to provide appropriate care and support. Safeguarding of children and vulnerable adults was understood and taken seriously by the practice, although we noted that not all staff had received relevant training. There was an involvement of patients through the patient participation group. The practice had an ethos of providing good patient care. Training that the practice required staff to complete yearly was not always up to date.

Our key findings were as follows:

• An active patient participation group working in partnership with the practice.
• CQC received 46 comment cards completed by patients all with positive feedback.
• Infection control audits and cleaning schedules were in place and the practice was seen to be clean and tidy.
• The practice had systems to keep patients safe including safeguarding procedures and means of sharing information about patients who were vulnerable.

• Patients’ needs were assessed and care was planned and delivered in line with current legislation.

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

Importantly, the provider must:

• The practice must ensure that yearly mandatory training for staff is completed and monitored to ensure that time frames for renewal do not lapse. This includes ensuring staff have completed relevant training for safeguarding children and vulnerable adults.

We have issued a compliance action regarding the regulation to support staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice