We carried out an announced comprehensive inspection at Emsworth Surgery on 19 March 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall. However, we rated Safe as Requires Improvement.

We rated the practice as Requires Improvement for providing safe services because:

• The practice did not ensure that all Patient Group Directions (PGDs) were appropriately authorised.
• The practice did not take appropriate action when fridge temperatures were recorded outside of the safe range.
• The practice did not have appropriate security to keep blank prescriptions safe from misuse.
• Emergency medicines were not available for every expected eventuality.
• Contaminated waste bins were locked but not secured.

We rated the following population groups as Good: people experiencing poor mental health, families, children and young people, people of working age, people whose circumstances make them vulnerable because:

• Childhood immunisation uptake rates were in line with the World Health Organisation (WHO) targets.
• The practice offered an extended hours service between 6.30pm and 7.30pm Monday to Thursday and between 7.30am and 8am Wednesday to Friday.
• The practice had appointed clinical leads for patients with dementia, carers and those who were veterans.
• Patients with a learning disability were visited in their own home rather than the practice to avoid distress.
• The practice had reduced its use of antipsychotic medicines for patients with dementia by developing a ‘Challenging behaviour formulary.’ This had resulted in an audited reduction in their use and improved GP notes regarding discussion of risks and benefits of the use of antipsychotic medicines.
• The practice worked with the PPG to reduce social isolation for elderly patients.

We rated the following population group as Requires Improvement: people with long term conditions, because:

• Exception reporting rates for long term conditions were high compared to the CCG and England averages. Although they had reduced as evidenced in recent reports provided by the practice, they remained high.

We rated the practice as Good for providing effective, caring, responsive and well-led services because:

• The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The way the practice was led and managed promoted the delivery of high-quality, person-centred care.
• People were able to access care and treatment in a timely way.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way for service users by ensuring the proper and safe management of medicines.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review systems for the safe storage of clinical waste.
• The practice should have practice leaflets in other languages available in the waiting area.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Emsworth Surgery on 23 July 2015. Overall the practice is rated as good.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Opportunity for learning from internal and external incidents and complaints was maximised.
• The practice had systems in place to improve outcomes for patients. The practice had updated the practice computer system with the Ardens tools, which is a clinical safety tool that assists in safer prescribing of medicines, recalling patients for routine checks and included templates to assist in the recording and management of patients’ treatment to improve outcomes.
• The practice had comprehensive systems in place to provide health promotion advice to patients, which included a quarterly newsletter and health education events at a local venue. The practice also referred patients to a lunch club that was organised by the patient participation group in order to reduce medical conditions associated with social isolation.
• Patients indicated that they were happy with the care and treatment that they received at the practice and the national GP survey indicated that the practice score was in line with Clinical Commissioning Group averages and above national averages for the care provided by GPs and nurses.
• Data for 2013 to 2014 indicated that the practice had achieved 93.85% of the total quality indicator points available compared to the national average of 94.2%

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

The provider should:

• Routinely record reviews and actions taken as a result of significant events and complaints.
• Ensure that the Health and Safety Policy has a date that it was written and a date for review. Also undertake and document health and safety audits.
• Ensure that there is a programme for infection control audits to be completed every six months.
• Ensure the disposal of all consumable stores that have passed their expiry date.
• Update the practice information leaflet to ensure it includes correct information such as current opening times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We reviewed the information available to us about Emsworth Surgery on 6 June 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.