Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. The practice was previously inspected on 21 January 2015 and rated Good.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

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 Eden Park Surgery on 21 January 2015 as part of our inspection programme. The overall rating for the practice was good. The full comprehensive report for 21 January 2015 can be found by selecting the ‘all reports’ link for Eden Park Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 19 December 2017. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014 as part of our inspection programme.

At this inspection we found:

• There was continuity of care for patients, as the practice provided a daily walk in service between 10.30am to 11.15am, where any patient could be seen.

• The practice never used locums.

• The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided.

• 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.

• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

• Patients told us that all staff at the practice were supportive and the care they received was excellent. Access to the service was good and patients told us they could book routine and emergency appointments when needed

The areas where the provider must make improvements are:

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Continue to review and improve how patients with caring responsibilities are identified and recorded on the clinical system to ensure that information, advice and support is made available to them.

• Review the frequency of testing electrical equipment.

• Review the safety of the storing of patient records.

• Review conducting staff meetings and documenting them.

• Review accessibility for patients with hearing impairment.

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 of Eden Park Surgery on 21 January 2015.

We found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for the population groups we report on: older people; people with long term conditions; families, children and young people; working age people including those recently retired and students; people in vulnerable circumstances and people experiencing poor mental health.

Our key inspection findings were as follows:

• There were systems in place for reporting, recording and monitoring significant events to help provide improved care.

• Staff were clear of their roles in regards to monitoring and reporting of incidents, safeguarding vulnerable people and children, and following infection prevention and control guidelines.

• Staff shared best practice through internal arrangements and meetings and also by sharing knowledge and expertise with external consultants and other GP practices.

• There was a strong multidisciplinary input in the service delivery to improve patient outcomes.

• Feedback from patients about their care and treatment was very positive.

• The practice was responsive to the needs of vulnerable patients and there was a strong focus on caring and on the provision of patient-centred care.

• The practice provided patients with information on health promotion and ill health prevention services available in the practice and the local community.

• The practice has a clear vision and strategic direction which was to improve the health, well-being and lives of those that they care for at the practice. Staff were suitably supported and patient care and safety was a high priority.

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

Importantly the provider should

• Ensure all practice staff are involved with and participate in meetings, the sharing of information and learning as a result of complaints and significant events.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice