Esher Green Surgery

Updated 14 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Esher Green Surgery on 22 December 2015. The practice had been rated as good for effective, caring, responsive and well-led, however, required improvement in safe. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensure that all recruitment checks were carried out and recorded as part of the staff recruitment process. This included retaining information for Disclosure and Barring Service (DBS) checks for those staff that need them, proof of identity, CV with full employment history and references and the completion of a risk assessment as to which staff required a criminal records check with the Disclosure and Barring Service (DBS).
• Completing a legionella risk assessment.

In addition the provider should:

• Ensure staff were aware of the business continuity plan.
• Ensure there was improved dissemination of information of patient care plans when carried out by the Advanced Nurse Practitioner.
• Ensure that the carpet in a treatment room was replaced with suitable flooring as specified in the practice refurbishment plan.

We undertook this announced focused inspection on 8 September 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and is rated as good under the safe domain.

This report only covers our findings in relation to those requirements.

• Staff recruitment files contained the relevant information and pre-employment checks had taken place. All staff had been risk assessed to see if their role required a DBS check.
• A legionella risk assessment had taken place in December 2015.

In addition we saw evidence that the provider had:

• Ensured all staff were aware of the business continuity plan and its location.
• Ensured GP involvement in care plans carried out by the Advanced Nurse Practitioner.
• Replaced the carpet in a treatment with suitable flooring.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 March 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• For patients with more complex diabetic needs there was a monthly clinic with the Diabetic Specialist Nurse.
• Patients were able to have 24 hour blood pressure monitoring.

Updated 3 March 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice ensured that children needing emergency appointments would be seen on the day or were offered a same day telephone appointment to discuss any concerns.
• We saw positive examples of joint working with midwives and health visitors.
• The practice promoted healthy living and had supporting information for preventing diabetes, heart disease, kidney disease, stroke and dementia advertised at the front desk, in the newsletter and on the practice website.
• The practice ran child developmental clinics and child immunisations at same time to help patients attend appointments.

Updated 3 March 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• Patients had a named GP which allowed for continuity of care.
• The practice had good relationships with a range of support groups for older patients.
• The practice endeavoured to assist patients to remain in their preferred place of care for as long as possible.
• The practice provided medical services for residential homes, two nursing homes and conducted regular visits.
• The practice had a safeguarding lead for vulnerable adults.
• There were arrangements in place to provide flu and pneumococcal immunisation to this population group.

Updated 3 March 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice offered advice by telephone each day for those patients who had difficulty in attending the practice.
• Patients could pre-book early morning appointments from 7:30am twice a week as well as one evening a month with appointments until 8pm.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice offered NHS over 40’s health checks.
• Electronic Prescribing was available which enabled patients to order their medicine online and to collect it from a pharmacy of their choice, which could be closer to their place of work if required.

Updated 3 March 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 95% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 3 March 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless patients and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice could offer a separate quiet waiting room for patients.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• Translation services were available for patients who did not use English as a first language.
• The practice could accommodate those patients with limited mobility or who used wheelchairs.
• The practice also provided an auditory loop in the practice and offered text messaging services to those with hearing difficulties.
• Carers and those patients who had carers, were flagged on the practice computer system and were signposted to the local carers support team.