Eltham Palace Surgery

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found the service was not providing safe care. This was because we were not assured that staff were able to access information regarding significant events, complaints, safeguarding concerns, and safety alerts that were discussed at practice meetings. Patients reported difficulty accessing prescriptions, whilst staff told us medicine queries were not always handled in a timely manner. Not all staff we spoke with knew who the safeguarding or infection prevention and control (IPC) leads were. Risks identified at our previous inspection in May 2023 relating to fire safety and IPC had still not been addressed. There was no evidence fire wardens had received additional training for their role. The provider had not effectively responded to all patient safety alerts. Immunisation status was not routinely collected for non-clinical staff.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients told us they were asked for their feedback and were able to raise concerns. Patients who had made a complaint, felt their complaint was taken seriously, and responded to in an appropriate manner. However, the link on the practice website directing patients to make a complaint did not work at the time of our assessment.

The provider maintained a log of significant events and had recorded 7 significant events in the last 12 months. The log included details of actions taken as a result of a review of each significant event. The provider told us significant events were discussed in practice meetings and we saw evidence of discussion in practice meeting minutes. The provider shared an example of a significant event with us. A patient had been given an urgent referral. When reviewed, it was found this patient had not received their appointment. The provider investigated and found this was the result of an error made by a new staff member. The staff member received additional training and learning was shared with the team. The provider had recorded 13 complaints in the last 12 months. We saw evidence that learning from complaints was discussed in practice meetings. We were not assured that communication between staff members was consistent. Some staff members told us they attended meetings where significant events and complaints were discussed. Others told us they did not attend meetings and were unsure how to access meeting minutes. Given that MHRA alerts, safeguarding concerns, and significant events were discussed during such meetings, we could not be assured that all staff were informed accordingly about information that could directly (or indirectly) impact patient safety.

The provider had policies and process for how to handle significant events and complaints. Staff were able to demonstrate the process for recognising and recording significant events and were aware of the complaints policy. We did not see a complaints policy in the reception area for patients. Staff told us there was information on the practice website about how to complain, and patients asking to make a complaint would be directed to speak with the practice manager. The practice website contained a link to the NHS website where feedback could be left. At the time of our assessment the link on the website where patients were directed to provide feedback to the practice did not work, users received an error message saying page not found.

We received 24 Give Feedback on Care (GFOC) forms regarding this practice. We found that 7 of these forms included negative feedback regarding access to medicines. Comments referred to delays in receiving medicine that had been requested by consultants and errors with prescriptions that were not corrected in a timely manner. Comments shared directly with CQC and on the NHS website referenced difficulties accessing referrals.

Staff understood the process for handling urgent referrals. Staff were able to explain their responsibilities for follow up to ensure patients had received and attended appointments. GPs told us they had systems to follow up with patients who had attended with symptoms that may indicate serious illness. Staff told us they felt GPs did not always action requests in a timely manner. Medicine queries were raised as a particular issue.

Partners had no specific feedback on this area.

There were systems to ensure urgent referrals were completed in an appropriate timeframe and staff were aware of their responsibilities for following up referrals. We found test results and documents were handled appropriately and in a timely manner. The provider had processes detailing how to handle repeat prescription requests, however patients told us there were often delays in receiving their medicines. Patients were offered appropriate safety netting advice in case their condition deteriorated.

Feedback from patients raised no concerns about safeguarding.

Leaders were able to explain how safeguarding concerns were managed within the practice. We were told safeguarding concerns were discussed in clinical and practice meetings. Leaders were able to share examples of actions taken by staff when raising concerns. Not all staff were able to identify the 2 safeguarding leads. The safeguarding leads as told to us by the practice were not named on the practice’s safeguarding policy but were named on a separate document named “Safeguarding register protocol”.

Partners did not raise any concerns about safeguarding.

At our previous inspection in May 2023, we found the provider was not assured all staff had completed safeguarding training and the provider did not hold evidence of Disclosure and Barring Service (DBS) checks for all members of staff. At this assessment in April 2024, we found 1 member of clinical staff had not completed the appropriate level of safeguarding children training applicable to their role. We found staff had received DBS checks before commencing work at the practice. There was a safeguarding policy with details of external contacts to raise safeguarding concerns. The provider kept a log of adults and children on the safeguarding register. Patients on the register were reviewed at clinical team meetings. The staff member named on the policy as the safeguarding lead was inconsistent with the information given to us by leaders at the practice and that recorded on the practice's safeguarding register protocol. We were told there was a safeguarding lead for adults and a safeguarding lead for children, however neither of these staff members were named on the practice’s safeguarding policy. They were however named on a separate document called “Safeguarding register protocol”.

Patients told us they felt involved in their care and treatment. Care and treatment was explained to patients in ways they could understand and were given options for their treatment, for example regarding referrals.

Staff told us there were systems to schedule appointments for patients with long term conditions, immunisations and screening tests. We were told children, or vulnerable individuals who were not brought or did not attend appointments, were flagged to practice management for follow up.

At our previous inspection in May 2023 we found hundreds of physical patient records that had not been summarised. At this assessment in April 2024 we were told there was a member of staff tasked with adding this information to patient’s digital records. However, we found 10 boxes of patient records that had not been summarised.

There was a document on a noticeboard in the practice advising there was a panic button on the front desk and in all GP rooms. However, staff were unaware of the panic buttons and told us in an emergency situation they would call or go to one of the GPs' rooms for help. Leaders were unsure whether the panic buttons on reception were functioning. Fire alarm testing took place each week. Testing of the emergency lighting system had taken place in February 2024.

At our previous inspection in May 2023, we found hundreds of physical patient records which needed to be summarised and added to patient records. This was identified at the fire risk assessment completed by the practice but not addressed at the time of our previous inspection. At this assessment in April 2024, we were told there was a medical summariser in post who was in the process of adding the patient information to digital records. However, we found the fire risk had not been addressed as there were 10 boxes of physical patient records awaiting summarising. There were designated fire wardens in the practice, however we did not see evidence these staff members had received fire warden training. The practice manager reported that additional training had been provided to those members of staff who were fire wardens; however, the practice was unable to produce certification to evidence this. There were building works ongoing in the practice which had resulted in dust in the reception area. The building was shared with other organisations and signage was not clear for patients. This resulted in a number of patients queuing at the practice reception desk who were then directed to other areas of the building. This was noted as an additional burden to practice staff. We were told there were plans to relocate the reception area within the next 6 months; practice leaders were hopeful this would alleviate the additional workload for reception staff. We observed equipment in clinical rooms and found several to be out of date, for example micropore, scissors and ear thermometer probe covers.

The practice held medicines and equipment to enable response to medical emergencies. There were processes to ensure emergency medicines and equipment were checked regularly.

Patients told us they had recognised the efforts taken by the practice to increase staffing levels through the use of long-term locum GPs and other healthcare professionals such as physiotherapists and clinical pharmacists. We also heard there remained difficulty accessing appointments; same day appointments could be accessed if patients contacted the practice when it opened but there was limited availability later in the day. Many patients told us they regularly had a 2-3 week wait for routine appointments.

Staff told us they felt there were enough staff to meet the demands of the patient population. The practice had recently recruited administrative and reception staff and were in the process of recruiting a reception manager and practice manager. Following our assessment, we asked the provider to provide an action plan based on the feedback at our site visit. We were told a business manager had been recruited and had commenced work at the practice. There was a plan to recruit additional reception staff, a reception supervisor and a deputy to the business manager. There were 2 GP partners at the practice and 5 regular locum GPs who provided appointments. Other healthcare staff included a clinical pharmacist, physician associate and physiotherapist.

There were processes in place to ensure pre-employment checks took place before staff commenced work in the practice. For example, Disclosure and Barring Service (DBS) checks. There was an induction process for new starters and staff received regular appraisals.

Patients told us they found the premises to be clean and tidy. Patients said they observed staff washing their hands before and after examinations and wearing gloves.

At our previous inspection in May 2023 the practice had identified through an infection prevention and control (IPC) audit that mops had been left in buckets rather than being hung up on the wall to dry. At this assessment in April 2024, we found this issue had not been addressed as mops were stored in buckets. It was unclear who the IPC lead was. Many staff members named a member of staff as the IPC lead; however this staff member was unable to confirm whether they were the lead and had not been involved in IPC audits. The practice’s IPC policy named a member of staff who no longer worked at the practice as IPC lead.

We observed an overfilled sharps bin in a clinical room. We raised this with the provider who confirmed the room was not used for clinical care and was used for storage. During our site visit, the sharps bin was removed from the room and replaced. Staff were able to identify signs of sepsis and actions required. However, there was no signage in the reception area to support staff to identify signs of sepsis.

We found that details of the immunisation status of clinical staff were kept and requested as part of the new starter checklist; however there were no such processes followed for non-clinical staff. This was raised with leaders at the practice who were unaware of the requirement of providers to ensure all staff who had direct contact with patients to be up-to-date with routine immunisations. The provider told us immunisation status would be added to the practice’s induction checklist for all staff. At our previous inspection in May 2023 we found not all staff had completed IPC training. At this assessment in April 2024, we viewed the training records of 6 staff members and found all had completed IPC training.

The findings from our clinical searches showed that patients’ medicines were not always managed in line with national guidance. For example, some patients prescribed a non-steroidal anti-inflammatory drug (NSAID) or an antiplatelet had not been prescribed a medicine to reduce stomach acid production in line with national guidance. Some patients had not been alerted of the associated risks of their medicines as per information received by the provider through safety alerts.

Reviews were offered to all patients with a learning disability. The provider shared evidence with us to show all patients with a learning disability had received an annual review in the last 12 months. Home visits were offered where appropriate. Some staff members told us that they did not feel GPs always actioned requests in a timely manner. For example, medication queries were raised as a particular issue. Staff were able to tell us the process for managing safety alerts, however our review of clinical records showed this was not followed for all relevant safety alerts.

We found patients prescribed a medicine to lower blood pressure were monitored in line with best practice guidance. We reviewed patients prescribed either a non-steroidal anti-inflammatory drug (NSAID) or an antiplatelet who met the criteria to need a prescription for a medicine to reduce stomach acid production. We found 34 patients had not been prescribed the medicine to reduce stomach acid production. We reviewed 5 of these patients and found all these patients required a prescription for this medicine. The provider shared information with us to show that attempts had been made to contact these patients regarding this issue. We were told these patients would be reviewed in May 2024 and the provider had an action plan for how these patients would be managed in the future.

At our previous inspection in May 2023 we found the provider was unable to demonstrate that all relevant safety alerts had been responded to. We also found that medicine reviews had been conducted without addressing required monitoring or changes to treatment that should have been identified during a comprehensive review. At this assessment in April 2024 we found the provider had a medicines policy which included a process for how to manage safety alerts. However, our clinical searches found actions associated with safety alerts were not always fully completed. We shared our findings with the provider who told us they had previously made some attempt to contact patients to make them aware of the risks associated with their medicine but these were not always successful. The provider also told us staff were not aware of the need to code safety advice. Following our assessment the provider shared details of a text message that had been sent to all patients with a mobile phone. The provider told us they were in the process of contacting patients without a mobile phone via alternative means. We looked at 5 medicine reviews and found that 4 reviews did not contain sufficient information.

At our previous inspection in May 2023 we found the practice was above the national average for prescribing antibiotics for urinary tract infections. At this assessment in April 2024, data showed appropriate prescribing of antibiotics, psychotropics (medicines prescribed to treat mental health disorders) and opioid and non-opioid analgesics (medicines to relieve pain). Prescribing of medicines to treat urinary tract infections was slightly higher than the expected figure, however improvements were seen when compared to the 2023 data. In addition the provider had carried out an audit on patients prescribed antibiotics for urinary tract infections.