At our last inspection in January 2014 we found that the provider was non-compliant with standards relating to infection control and medication management. We identified that the provider did not have a comprehensive written specification or cleaning checklists for cleaning the general and clinical environment. We also found that emergency medication was located in two different areas and clinical staff were not clear which medications were for emergency use or why they had been stored in the way they had been.

During this inspection we found that the surgery had developed a cleaning specification and had updated cleaning schedules which now took account of high, medium and low risk areas of the practice including clinical and non - clinical areas of the practice We reviewed the stock management process for medicines. We saw that all expiration dates were now being recorded and checked weekly. We reviewed emergency medications and found that a new storage bag had been purchased to organise all emergency medications and to enable staff to easily identify what may be required during an emergency situation. A new managing medicines policy and protocol is now in place.

Patients understood the care and treatment choices available to them. The practice was open Monday to Friday with extended opening hours two evenings a week. Appointments with a GP lasted 10 minutes but longer appointments were available at the GP's discretion. Appointments with the nurse were either 15 or 30 minutes long. We spoke with six people who used the service. One person told us "the GP takes time to listen to what I have to say."

We saw that a patient survey was underway and we looked at some responses and suggestions. We noted that some improvements had occurred as a result, there was now a suggestion box in the reception area and a new patient check in system had been installed.

Patient privacy and dignity was respected. Consultations took place behind closed doors and clinical staff asked patients permission before examining them.

Patients told us they were very satisfied with the service they received from their GP and nurse. A patient described the service as "a real family orientated practice" and another patient told us "it is brilliant here, they know me and my family so well." Patients told us that the referral process was efficient and that they were offered an element of choice where they could be seen for a specific condition.

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 “takes whatever time is needed, I don't feel rushed to finish what I am saying."

Contracts were in place for general cleaning and the removal of clinical waste. However, although there was a basic cleaning schedule, there was no comprehensive written specification or cleaning checklists for cleaning the general and clinical environment.

We found no management of medicine policy or procedure in place at the practice. This meant that the provider may not be managing the risks associated with medicines handling.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at JS Adler and F Rosenberg on 2 March, 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 in place for reporting and recording 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.

The areas where the provider should make improvement are:

• Review how they inform and educate patients about the importance of the cervical smear screening programme and childhood vaccines to increase uptake.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice