This practice is rated as Good overall. (Previous inspection December 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Eastfield House Surgery on 20 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. For example, clinical staff received enhanced training to deal with a range of life threatening conditions that patients might encounter whilst at the practice.
• The practice ran a personalised list system to deliver continuity of care for patients.

• There was a focus on prevention of health problems arising. This included scanning for liver problems, pre diabetes assessments and dementia screening.
• There were effective systems in place to monitor usage of prescribed medicines. Data showed that 99% of patients taking four or more repeat medicines had received a review of their medicines in the last year.The practice employed practice matrons to support patients with complex needs and those whose condition made it difficult to attend the practice for appointments. For example, patients who had mental health problems and did not wish to attend the practice could be seen at their own home.

The areas where the provider should make improvements are:

• Monitor the systems changes made on the day of inspection to evaluate their effectiveness and sustainability.
• Review the implementation of annual health checks for patients diagnosed with a learning disability.

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 focused inspection at Eastfield House Surgery on 2 December 2015. This inspection was to follow up on concerns identified at the last inspection in June 2015.

During the June inspection, we found concerns relating to the investigation and reporting of significant events; the safety checks of GP bags, the storage of prescriptions; legionella risk assessment and testing and staffing recruitment checks. Policies and procedures relating to the Mental Capacity Act and safeguarding reporting were not completely understood by staff. Following the inspection the provider sent us an action plan detailing how they would improve the areas of concern.

We carried out a focussed inspection of Eastfield House Surgery on 2 December 2015 to ensure these changes had been implemented and that the service was meeting the requirements of the regulations. Our previous inspection in June 2015 had found two breaches of the regulations relating to the safe delivery of services. The ratings for the practice have been updated to reflect our findings. Overall the practice is now rated as good.

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

• The system to report and investigate significant events and complaints had been reviewed. We found processes in place which demonstrated a complete investigation and review of events and complaints, and included the actions undertaken.

• A process had been implemented to regularly check the expiry dates for medicines held within the GP bags.

• Blank prescriptions were stored securely at all times.

• Background and recruitment checks were completed for staff. This included Disclosure and Baring Service (DBS) checks for all clinical staff and other staff undertaking chaperone duties.

• Safeguarding training had been completed by the nursing team and all staff were aware of the reporting process.

• A clear audit programme had been implemented to drive continuous improvement and better patient outcomes.

• Training had been provided in the Mental Capacity Act and staff were aware of the principles of the Act and how best interest decisions were applied.

• Policies and procedures were accessible to all staff. Including those for safeguarding adults and children, whistleblowing and the Mental Capacity Act.

We have changed the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe and effective services.

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 Eastfield House Surgery on 2 June 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe and effective services. It also required improvement for providing services for the all population groups as the concerns we identified relate to all these groups. It was good for providing caring, responsive and well-led services.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety including incidents and complaints was recorded, but was not always investigated and acted on to ensure improvements to safety and effectiveness were made.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks. There were minor concerns regarding the management of medicines.
• Data showed patient outcomes were average for the locality. Although some audits had been carried out, we saw limited evidence that audits were driving improvement in performance to improve patient outcomes.
• 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.
• Availability of appointments for advanced or routine booking was excellent.
• Urgent appointments were usually available on the day they were requested, although patient feedback suggested that same day appointments were sometimes difficult to book.
• The practice had a number of policies and procedures to govern activity, but they were sometimes difficult to locate or not complete.
• The practice held regular governance meetings and issues were also discussed at ad hoc meetings.
• The practice had proactively sought feedback from staff or patients.
• The Patient Participation Group (PPG) was a virtual group which was consulted with but had no direct involvement in the running of the service.

We saw one area of outstanding practice including:

• A cardiovascular clinic was provided onsite meaning patients who needed this service did not have to travel to local hospitals.

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

The areas where the provider must make improvements are:

• Review the process for investigating and implementing change from incidents, significant events and complaints to ensure objective clinical review is undertaken and actions are completed.
• Update procedures for checking medicines, specifically those in GPs home visit bags.
• Provide a process for checking blank prescription forms are always used appropriately.
• Undertake a full risk assessment for legionella and any programme of testing required
• Ensure appropriate staff background checks are undertaken and information required under the regulations is kept by the practice.
• Ensure protocols and policies are understood by staff and used consistently across the practice.

The areas the provider should make improvements are:

• Ensure safeguarding procedures are reviewed by staff so they are aware who to contact within the practice and externally.

• Develop a clear programme of audit used to identify and drive clinical improvement and outcomes for patients.
• Ensure staff are able to follow the principles of the Mental Capacity Act 2005.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice