- GP practice
Peartree Surgery and West Horndon Surgery
All Inspections
31 July 2017
During an inspection looking at part of the service
Letter from the Chief Inspector of General Practice
On 1 June 2016 we carried out a comprehensive inspection at Dr Amanda M Davies and Dr C S Jayakumar also known as Peartree Surgery. Overall the practice was rated as requires improvement. The practice was found to be good in providing safe, caring and responsive services. However, they required improvement in providing effective and well-led services. Issues highlighted at the June 2016 inspection were related to the monitoring of patients with long term conditions and the absence of quality improvement processes such as clinical audits to drive improvement. The full report for the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Amanda M Davies and Dr C S Jayakumar on our website at www.cqc.org.uk.
We carried out a focused inspection of the practice on 31 July 2017 to establish whether the improvements required had been met. We found the practice had made appropriate improvements; overall the practice is rated as good.
Our key findings across all areas we inspected were as follows:
- The practice had improved their clinical performance in respect of QOF. Published figures from 2015/2016 showed the practice had achieved 85% of their total QOF points. Unverified figures showed the practice had improved to 94% in 2016/2017.
- The practice had improved exception reporting by monitoring their patient lists closely.
- The practice had monitored their patients with long term conditions and improved their outcomes.
- The practice had conducted audits to review patients care and drive improvement.
- Their patients experiencing mental health conditions were reviewed and treated in line with their needs and current guidelines.
- The practice had identified 71 patients as a carer which was 1% of their patient list. Carers were offered a range of services and information relating to addition support groups and they were given regular health checks.
- The practice had reviewed their data from the national GP patient survey and conducted internal patient surveys to monitor patient satisfaction.
- The practice had addressed their staffing issues experienced during the previous inspection in June 2016.
- Staff understood their roles and responsibilities and how these contributed directly to improving patient experiences of the service and the practices performance.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
1 June 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Amanda M Davies and Dr C S Jayakumar on 1 June 2016. Overall the practice is rated as requires improvement.
Our key findings across all the areas we inspected were as follows:
- Staff were aware of their responsibilities regarding safety, and reporting and recording of significant events. There were policies and procedures in place to support this.
- The practice assessed risks to patients and staff. There were systems in place to manage these.
- Patients’ care and treatment was assessed and delivered based on the current evidence based guidance.
- Staff received appropriate training to provide them with the necessary skills, knowledge and experience to fulfil their role. They had access to further role specific training if appropriate.
- Patients said they felt the practice offered an excellent service and staff were helpful, caring and treated them with dignity and respect.
- Information about how to complaint was available for patients both online and in the practice building itself. Complaints investigations and documentation showed that improvements were made to the quality of service provision as a result.
- Patients said it was difficult to access same day appointments due to the length of time to get through to a receptionist on the telephone and often no appointments were left.
- There were limited quality improvement activities, such as clinical audits, taking place.
- The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient forum. For example, the practice had recruited an additional GP in response to feedback about the lack of availability of appointments. The GP had only recently start work at the practice.
- The practice facilities met the needs of its patient population.
- There was a good management structure and staff told us they felt supported and involved in the development of the practice.
- The culture of the practice was open and honest, and the practice complied with the requirements of the duty of candour.
The areas where the provider must make improvement are:
- Implement a quality improvement programme including clinical audit to ensure that the findings can be used to drive improvements in the quality of patient care.
- Ensure robust systems are in place so that all patients with a long term condition and those suffering with poor mental health receive appropriate reviews.
The areas where the provider should make improvement are:
- Improve the identification of carers on their practice register.
- Ensure continued monitoring and improvement in relation to national GP patient survey results.
- Ensure robust systems are implemented to ensure good governance and consider contingency arrangements to ensure appropriate staffing levels at all times.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
5 March 2014
During an inspection looking at part of the service
These concerns related to the provider not having an effective procedure in place to deal with emergencies. In addition we found concerns about the lack of procedures and guidance for dispensing work. There were not appropriate arrangements in place for the obtaining, recording and disposal of controlled drugs. We also found that the process for learning from significant events was not followed.
During our inspection on 05 March 2014 we found that improvements had been made.
We saw that there was a business continuity plan in place at both surgeries. We spoke with two members of staff, both of whom were able to locate this immediately when we asked to see it.
We found guidance was available for dispensing work and there were appropriate arrangements in place for the obtaining, recording and disposal of controlled drugs. We spoke with one member of dispensing staff who told us, "Things are safer. We have guidance for controlled drugs.'
We found that there was an effective process in place for analysing and learning from significant events.
We visited the main surgery and the branch surgery as part of our inspection.
31 October 2013
During a routine inspection
We saw that the surgery staff worked in collaboration with other professionals to meet the needs of the people who used the surgery.
The surgery had equipment and medicines in order to respond to a medical emergency. They did not have a procedure in place in order to respond to an emergency which would affect the provision of services.
The branch surgery was the main dispensing premises, so this site was also visited on the day of our inspection. We found that for dispensing work, the staff had no guidance to follow which could increase the risks associated with medicines. We found inconsistencies in the accounting of controlled drugs.
We saw that the surgery did take action in response to feedback from people who used the surgery. We saw that a system was in place for analysing and learning from significant events, however this was not followed for all significant events.
We spoke with five people, all of whom said they knew how to complain about the service provided by the surgery. One person told us, 'I know the complaints procedure but I have not needed to use it.' We reviewed eight complaints. Each had been investigated and a written response provided to the complainant, with an apology if that was appropriate.