The Care Quality Commission
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Archived: The Guildford Rivers Practice Also known as Hurst Farm Surgery

Overall: Good read more about inspection ratings

Hurst Farm Surgery Chapel Lane, Milford, Godalming, Surrey, GU8 5HU (01483) 415885

Provided and run by:
The Guildford Rivers Practice

All Inspections

18 November 2021

During an inspection looking at part of the service

We carried out an announced inspection at The Guildford Rivers Practice on 18 November 2021 Overall, the practice is rated as Good

Set out the ratings for each key question

Safe - Good

Effective - Good

Caring – not inspected

Responsive – not inspected

Well-led - Good

Following our previous inspection on 11 December 2019, the practice was rated Requires Improvement overall and Requires Improvement for Safe and Effective. Caring, Responsive and Well Led were all rated as Good.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Guildford Rivers Practice on our website at www.cqc.org.uk

Why we carried out this inspection

The practice had been previously rated as Requires Improvement in December 2019. This inspection was to follow up breaches of regulations 12, and 18 as identified in our previous inspection. The previous ratings for caring and responsive which were rated as Good are carried forward.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short site visit

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall

We found the practice had responded to the issues raised at the previous inspection.

  • Systems and processes for keeping patients safe had been improved.
  • The practice completed yearly infection control audits.
  • Safety alerts and significant events were acted upon and learning disseminated amongst staff.
  • The advanced nurse practitioner was meeting with one of the GP partners on a monthly basis and prescribing was being monitored.
  • Medication reviews for low risk medicines were recorded on patient notes.
  • Second cycle audits were being completed.
  • Mandatory training was up to date.
  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

The provider should:

  • Review and improve how medication reviews are coded within the clinical system
  • Review and improve the tracking of prescription paper for individual rooms

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

11 Dec 2020

During a routine inspection

We carried out an announced comprehensive inspection at The Guildford Rivers Practice on 11 December 2019 as part of our inspection programme.

We had previously carried out an announced comprehensive inspection at The Guildford Rivers Practice in October 2014 and a follow up inspection in August 2015. The practice was last rated as Good overall and Good in all domains. All of the practices’ previous reports can be found by selecting the ‘all reports’ link for The Guildford Rivers Practice on our website www.cqc.org.uk

We carried out an inspection of this service due to the length of time since the last inspection. Following our review of the information available to us, including information provided by the practice, we focused our inspection on the following key questions:

  • Is it Safe
  • Is it Effective
  • Is it Caring
  • Is it Responsive
  • Is it Well led

We have rated this practice as requires improvement overall, with safe and effective being requires improvement and caring, responsive and well led being good. All of the population groups have been rated as requires improvement as the concerns found in the effective domain affect all of the population groups.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We rated the practice requires improvement for providing safe and effective care because:

  • Some of the systems and processes in place to keep patients safe required improvement. For example: the practice had not completed a recent infection prevention control audit and safety alerts and significant events were being acted upon but the recording of this was not sufficient. The practice was not monitoring the Advanced Nurse Practitioner’s prescribing and the monitoring of low risk medication reviews were not always recorded on patients notes or being completed before further prescriptions were issued.
  • Lack of completion of second cycle audits and gaps in staff training meant that the practice was not always being effective in the way it managed its service.

We rated the practice good for providing caring, responsive and well led care because:

  • Patients received care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs.
  • Patients could access care and treatment in a timely way.
  • There was a clear leadership structure and staff felt supported by management.
  • Staff worked well together as a team and all felt supported to carry out their roles. There was a strong team ethos and culture of working together for a common aim.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out their duties.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Review and continue to monitor cervical screening to meet the Public Health England screening rate target.
  • Review and improve child immunisation rates to meet World Health Organisation (WHO) targets.
  • Review the fire risk assessment to ensure it covers fire marshals and the way in which the alarm is raised.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

13 August 2015

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Guildford Rivers Practice on 29 October 2014. The practice was found to require improvement for providing safe, effective and well led services. The practice was also found to require improvement in providing services for people with long-term conditions and people whose circumstances may make them vulnerable.

Following the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the regulations in relation to the following:

  • Ensure consistent arrangements to provide support to staff by means of appropriate supervision, appraisal and professional development.
  • Introduce a process of audit of infection control processes.
  • Ensure recruitment processes include all required pre-employment checks in order to minimise the risks to the health, safety and welfare of patients.
  • Ensure risk assessment and monitoring processes effectively identify, assess and manage risks relating to the health, safety and welfare of patients and staff.

Our previous report also highlighted areas where the practice should improve:

  • Seek to gather feedback from patients via patient surveys and the establishment of a patient participation group.
  • Establish a process to ensure more formal sharing of information and encourage continuous learning and improvement of all staff.
  • Identify and monitor the risks associated with the role of the outreach nurse in visiting vulnerable patients within their own homes.
  • Ensure a consistent approach to the use of alerts on the practice’s electronic records system in order to highlight vulnerable children and adults.
  • Develop a practice website to improve patient access to information relating to the practice and facilitate on line appointment bookings.

We undertook this focused inspection on 13 August 2015 to check that the provider had followed their action plan and to confirm that they now met the regulations. At this inspection we found the practice was good for providing safe, effective and well led services. The practice was also good for providing services for people with long-term conditions and people whose circumstances may make them vulnerable.

Our key findings across the areas we inspected were as follows:

  • The practice had developed processes to ensure all staff received an appraisal and were supported by a personal development plan.
  • Training was planned to support individual learning needs and promote professional development.
  • A series of regular meetings and training events within the practice encouraged sharing of information and continuous improvement.
  • Recruitment processes included all required pre-employment checks to minimise the risks relating to the health, safety and welfare of patients.
  • The practice had undertaken an audit of infection control processes.
  • Risk assessment and monitoring processes had been implemented in areas such as fire safety, legionella, infection control and the role of the outreach nurse.
  • The practice had reviewed its use of alerts to ensure these were used consistently to highlight vulnerable children and adults.
  • The practice had established a patient participation group (PPG) and was planning to undertake a patient survey.
  • The practice had reviewed the content of its patient information leaflet to improve information available to patients.
  • Access to online appointment bookings and repeat prescription requests were available via the practice’s NHS Choices website.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

29 October 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of The Guildford Rivers practice on 29 October 2014. We visited the practice location at Hurst Farm Surgery, Chapel Lane, Milford, Surrey GU8 5HU.

We have rated the practice as requires improvement. Although some aspects of the practice were good, areas of improvement were required. The inspection team spoke with staff and patients and reviewed policies and procedures implemented throughout the practice. The practice was responsive to the needs of the local population and engaged effectively with other services.

Our key findings were as follows:

  • There was a range of appointments to suit most patients’ needs. Patients reported good access to the practice and a named GP or GP of choice, with urgent appointments available the same day.
  • The practice engaged effectively with other services to ensure continuity of care for patients.
  • Patient feedback showed that patients felt they were involved in making decisions about their care and were treated with kindness and respect.
  • The practice had implemented an innovative approach to meeting the needs of vulnerable patients by developing an ‘outreach nurse’ role to visit those patients in their own homes and to coordinate all aspects of their care and support. However, risks associated with this role had not been fully assessed by the practice.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure consistent arrangements to provide support to staff by means of appropriate supervision, appraisal and professional development.
  • Introduce a process of audit of infection control processes.
  • Ensure recruitment processes include all required pre-employment checks in order to minimise the risks to the health, safety and welfare of patients.
  • Ensure risk assessment and monitoring processes effectively identify, assess and manage risks relating to the health, safety and welfare of patients and staff.

The provider should:

  • Seek to gather feedback from patients via patient surveys and the establishment of a patient participation group.
  • Establish a process to ensure more formal sharing of information and encourage continuous learning and improvement of all staff.
  • Identify and monitor the risks associated with the role of the outreach nurse in visiting vulnerable patients within their own homes.
  • Ensure a consistent approach to the use of alerts on the practice’s electronic records system in order to highlight vulnerable children and adults.
  • Develop a practice website to improve patient access to information relating to the practice and facilitate on line appointment bookings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice