Sellindge Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sellindge Surgery on 20 December 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Sellindge Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 20 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

• The practice had risk assessments and management activities that included all risks to patients, staff and visitors, for example, fire safety evacuations.
• The practice had ensured that medicines management procedures for vaccines complied with Public Health England (PHE) guidance. There was an effective process for managing safety alerts including those from the Medicines and Healthcare products Regulatory Agency (MHRA).
• All prescriptions, including those for schedule 2 and 3 controlled drugs were signed prior to medicines being dispensed and transferred to patients.

• There were appropriate recruitment checks for all members of staff, including locum GPs.

• There was a comprehensive staff induction program that included nursing staff.

• Training had been reviewed to help ensure that all staff received appropriate support.

• We saw that internal audits such as infection prevention and control, health and safety and legionella were implemented effectively.

The practice had also taken appropriate action to address areas where they should make improvements:

• Emergency medicines had been reviewed to help ensure appropriate medicines were available.

• The practice monitored patients receiving anticoagulation therapy from another service provider.

• The practice had reviewed its management of the Quality and Outcomes Framework (QOF) data to help ensure information was effectively recorded.

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 Sellindge Surgery on 20 December 2016. Overall the practice is rated as requires improvement.

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 for reporting and recording significant events.
• Not all risks to patients were assessed and well managed. For example, legionella monitoring, fire safety and medicines management. The practice did not always have regard to national guidance on infection prevention and control.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, the practice was unable to demonstrate recruitment checks had been completed for all locum GPs employed directly by the practice or for locum GPs employed via an agency.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had a care liaison officer who helped promote the role of carers both within the practice and locally. The practice ran an annual ‘carers week’ and carers were invited to the practices health promotion events including a ‘care for carer’s’ event.
• The practice had identified their patient population contained a higher than average amount of patients with learning disabilities and had responded by providing a program of support for this patient group.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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.

We saw several areas of outstanding practice:

• The practice had identified the higher than average amount of patients with learning disabilities in their patient population and had responded by providing extra training for staff, a learning disability communication folder and bespoke desensitising programs for patients that would benefit from these.
• Patients were empowered to have a voice within the practice through the collaborative partnership between the patient participation group (PPG) and the practice. The practice and PPG had a strong focus on working together to improve outcomes for patients. For example, a program of health promotion events.

The areas where the provider must make improvement are:

• Ensure risk assessments and management activities include all risks to patients, staff and visitors. For example, fire safety evacuations.
• Ensure internal audits such as infection prevention and control, health and safety and legionella  are implemented effectively and have action plans recorded.
• Ensure medicines management procedures for vaccines have regard to Public Health England (PHE) guidance and that there is an effective process for managing medicine alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).
• Ensure all prescriptions for schedule 2 and 3 controlled drugs are signed prior to dispensing and transfer to patients.
• Ensure all appropriate recruitment checks are carried out for all members of staff, including locum GPs.
• Ensure staff induction programs include nursing staff and review staff training to help ensure that all staff receive appropriate support.

The areas where the provider should make improvement are:

• Repeat prescriptions should be signed before medicines are transferred to the patient.
• Review emergency medicines to help ensure appropriate medicines are available or provide a risk assessment as to why these are not deemed necessary.
• Review the system for monitoring patients receiving anticoagulation therapy from another service provider.
• Review the system for managing Quality and Outcomes Framework (QOF) data to help ensure information is being effectively recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice