14 June 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Tehmton Sepai on 14 June 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 in most cases.
- 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 there was continuity of care, with urgent appointments available the same day.
- 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 improvements are:
- Complete the daily checks as identified in the Legionella risk assessment, take any required action following these checks and continue to make efforts to ensure the landlord completes the required action to manage all risks as identified in the Legionella risk assessment.
- Complete regular fire drills in accordance with the practice’s fire safety policy.
- Change the taps in the patient toilet to meet the required specification.
- Continue to try to re-establish the patient participation group and address the lower than average satisfaction scores in the national patient survey.
- Continue to work with the patient participation group to ensure members are informed and involved in how improvements could be made for the benefit of patients and the practice.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice