The Care Quality Commission
  • Doctor
  • GP practice

Angel Hill Surgery

Overall: Good read more about inspection ratings

1 Angel Hill, Bury St Edmunds, Suffolk, IP33 1LU (01284) 753008

Provided and run by:
Angel Hill Surgery

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Angel Hill Surgery on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Angel Hill Surgery, you can give feedback on this service.

24 April 2020

During an annual regulatory review

We reviewed the information available to us about Angel Hill Surgery on 24 April 2020. 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.

8 January 2018

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Angel Hill Surgery on 4 October 2016. The practice was rated as good for providing caring and responsive services, requires improvement for providing effective and well led services and inadequate for providing safe services. Overall the practice was rated as requires improvement. The full comprehensive reports on the 4 October 2016 inspection can be found by selecting the ‘all reports’ link for Angel Hill Surgery on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection at Angel Hill Surgery on 26 June 2017.The practice was rated as good for providing effective, caring, responsive and well led services and requires improvement for providing safe services. Overall the practice was rated as good. The full comprehensive reports on the 26 June 2017 inspection can be found by selecting the ‘all reports’ link for Angel Hill Surgery on our website at www.cqc.org.uk.

We undertook a desk based inspection on 8 January 2018 to check they had followed their action plan and to confirm they now met legal requirements in relation to the breaches identified in our previous inspection on 26 June 2017. 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, and good for providing safe services.

Our key findings from this inspection were as follows:

  • The practice used a local taxi company to provide a medicine delivery service to housebound patients. The practice had undertaken a risk assessment and had appropriate policies and monitoring in place.
  • Medical equipment had been calibrated and the practice had a system to alert them when this needed to be completed again.
  • The arrangements for the security of the dispensary ensured that medicines were kept secure and only accessible to authorised staff. The practice was based in a listed building and architect plans had been submitted to the council planning office, and a response was being awaited by the practice, in order to further improve the security of the dispensary.
  • The practice had continued to explore improvements to the arrangements for the security of the dispensary to ensure medicines were kept secure and accessible only to authorised staff.
  • Infection control training had been completed by all staff, including dispensary staff.
  • There was an effective and embedded process for reviewing, sharing and acting upon all National Institute for Health and Care Excellence (NICE) evidence based guidance within the practice. Lead clinicians were responsible for discussing evidence based guidance at educational meetings and we saw evidence to demonstrate this. The practice regularly audited that NICE evidence based guidance was being implemented.

The areas where the provider should make improvement are:

  • Continue to explore improvements to the arrangements for the security of the dispensary to ensure medicines are kept secure and accessible only to authorised staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

26 June 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Angel Hill Surgery on 4 October 2016. The practice was rated as good for providing caring and responsive services, requires improvement for providing effective and well led services and inadequate for providing safe services. Overall the practice was rated as requires improvement. The full comprehensive reports on the 4 October 2016 inspection can be found by selecting the ‘all reports’ link for Angel Hill Surgery on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection at Angel Hill Surgery on 26 June 2017. 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.
  • Patient safety alerts were logged, shared and initial searches were completed and the changes effected.
  • Risks to patients were generally assessed and managed, however the calibration of medical equipment, which was due in October 2016 had not been undertaken and the arrangements for the delivery of medicines by a taxi company had not been risk assessed.
  • Improvements had been made to ensure that patients had received appropriate monitoring and review before high risk medicines were prescribed. In addition, changes to patients’ medicines following discharge from hospital and outpatient appointments, were undertaken following instruction from the GP, and prescriptions were reviewed and signed by the GP before they were given to the patient.
  • The arrangements for the security of the dispensary did ensure that medicines were kept secure and only accessible to authorised staff. The practice was based in a listed building and architect plans had been submitted to the council planning office, and a response was being awaited by the practice, in order to further improve the security of the dispensary.
  • Improvements had been made in relation to infection control, including the identification and training of lead nurses, updated policies and audits with evidence of improvement. Infection control training had been scheduled for all staff although this had not yet been completed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. There was scope to embed the newly established process to ensure that all National Institute for Health and Care Excellence (NICE) audits were repeated as appropriate.
  • Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However not all staff we spoke with understood the relevant consent and decision making guidance.
  • The majority of patients reported that 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 improvements were made to the quality of care as a result of complaints and concerns.
  • The majority of patients said they were able to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. Three patients reported that there was often a wait to get through on the telephone in the mornings. The practice were aware and had taken actions to try to address this.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure with a relaxed and friendly management style, and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider must make improvement are:

  • Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvement are:

  • Continue to explore improvements to the arrangements for the security of the dispensary to ensure medicines are kept secure and accessible only to authorised staff.
  • Ensure that infection control training is completed by all staff.
  • Embed the newly established process to ensure that all National Institute for Health and Care Excellence (NICE) audits are repeated as appropriate.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

4 October 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Angel Hill surgery in Bury St Edmunds on 4 October 2016. Overall the practice is rated as requires improvement.Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was mostly recorded, monitored, appropriately reviewed and addressed.
  • The practice’s clinical monitoring systems and processes, including medicine review dates for patients, did not always provide GPs with good prescribing oversight.
  • Risks to patients were assessed and generally well managed but there was improvement required around infection control and medical updates and alerts monitoring.
  • 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.
  • Staff files and recruitment procedures were not always documented or governed thoroughly.
  • Information about services and how to complain was available and easy to understand.
  • 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 must make improvement are:

  • Ensure robust arrangements for the security of the dispensary are in place to ensure medicines are kept secure and accessible only to authorised staff.
  • Ensure compliance with the Health and Social Care Act 2008; code of practice for health and adult social care on the prevention and control of infections.
  • Authorisation must be in place for healthcare assistants to be able to administer vaccinations that they have received appropriate training for.
  • Ensure that an appropriately qualified clinician checks and approves changes to patients’ medicines following discharge from hospital and outpatient appointments.
  • In line with NICE (National Institute for Health and Care Excellence) guidance undertake regular audits for minor surgery.

In addition the provider should:

  • Ensure robust arrangements for the security of the dispensary are in place to ensure medicines are kept secure and accessible only to authorised staff.
  • The practice should be able to provide evidence of actions taken in response to relevant alerts and updates issued from the Medicines and Healthcare products Agency (MHRA) and through the Central Alerting System (CAS).
  • Maximise the functionality of the computer system in order that the practice can run clinical searches, provide assurance around patient recall systems, consistently code patient groups and produce accurate performance data.
  • Ensure that doctors involved in emergency home visits have a process in place to ascertain that the appropriate emergency medicines and diagnostic equipment is carried.
  • Ensure minutes of meetings contain information on decision making processes.
  • Ensure clinical audits are undertaken and recorded appropriately, clearly defining outcomes, responsibilities and learning points.
  • Ensure that the recruitment policy is in line with Schedule Three of the Health and Social Care Act and that governance around staff files and recruitment procedures is implemented and recorded effectively.
  • Ensure development needs from staff appraisals are met timely.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

8 July 2014

During an inspection looking at part of the service

During our inspection on 27 February 2014, we found the service did not have adequate processes in place to ensure the safe management of medicines. In addition we found that not all staff had received the support they should, such as individual appraisals or essential training.

We visited Angel Hill surgery on 8 July 2014 to check that the compliance actions set following our inspection on 27 February 2014 had been completed. We met with the practice manager and spoke with the lead dispenser of medication. We did not speak with patients on this occasion, but did include their comments as part of the original inspection.

There were systems in place to audit the expiry dates and usage of medications. We found the provider had taken action to ensure the safe storage and disposal of controlled drugs. These are medicines controlled under the Misuse of Drugs legislation. In addition medicines were dispensed, stored and recorded correctly. Improvements had also been made to ensure the safe keeping of refrigerated medicines and medication used by the practice nurses during their clinics.

Nursing staff had received an annual appraisal. Staff had received training required by the provider and were supported to complete further professional development when appropriate to do so.

27 February 2014

During a routine inspection

During our inspection we spoke with seven people who used the service. All of the people we spoke with were positive about the service. One person we spoke with told us, 'I've never had a bad experience here. They always give me a good service.' Another person told us, 'I've always really liked it and I have never had any problems.'

We found care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw there were arrangements in place to deal with foreseeable emergencies.

As part of our inspection we examined arrangements in place to dispense medicines. We found medicines including controlled medicines were not always dispensed, stored or recorded correctly. We also found there was no process in place to check the storage temperature in the medicines fridge.

We spoke with eight members of staff and examined staff records. We found staff received some training and support relevant to their role. We found not all staff received the support they should such as individual appraisals or essential training.

During our inspection we looked at the system in place to review and learn from clinical incidents and near misses. We found there was evidence that learning from incidents, investigations took place and appropriate changes were implemented.

We examined the written records for three complaints. We found there was an effective complaints system in place to acknowledge, investigate and respond to complaints.