Capelfield Surgery

Updated 27 March 2017

The Capelfield Surgery is situated in the Claygate area of Esher. The practice is located in a purpose built property owned by the partners. At the time of our inspection there were approximately 7,700 patients on the practice list. The practice has three female GP partners and two salaried GPs (one male, one female), one nurse, two healthcare assistants, two phlebotomists, a practice manager, reception and administration staff. The practice is open between 8am and 6.30pm Monday to Friday. Extended hours surgeries are offered 9am to 12pm every Saturday. Patients requiring a GP outside of normal hours are advised to call 111 where they are redirected to the most appropriate external out of hours service. The practice has a General Medical Services (GMS) contract. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. The practice offers enhanced services for example; various immunisation schemes.

The service is provided at the following location:

Capelfield Surgery

Elm Road

Claygate

Esher

Surrey

KT10 0EH

The practice population has a higher number than average of younger patients from birth to 14 years and patients from 40 to 54 years. It has a lower number than average of patients from 20 to 34 years. It also has a lower than average percentage of patients with long standing health conditions and of patients with health-related problems in daily life.

The CQC (Registration) Regulations 2009 require a GP partnership to have a registered manager and to be registered for all the regulated activities that they provide. Capelfield Surgery do not currently have a registered manager although they have started the application process and are not registered to provide maternity and midwifery services which they are providing.

Updated 27 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Capelfield Surgery on 21 January 2016. The overall rating for the practice was good, but breaches of legal requirements were found in the safe domain. The practice sent to us an action plan detailing what they would do in relation to the shortfalls identified and the action taken in order to meet the legal requirements in relation to the following:-

• The practice did not have a system for production of Patient Specific Directions to enable Health Care Assistants to administer vaccinations after specific training when a doctor or nurse were on the premises.
• Clinical specimens were seen to be stored in the same fridge as medicines which does not comply with the Public Health England Protocol for ordering, storing and handling vaccines.
• Printer prescription paper was not monitored within the practice and large quantities of prescription paper were observed left in printers with the rooms left unlocked.
• The practice was unable to provide evidence that an evacuation drill had been carried out.
• There was a wall mounted mercury sphygmomanometer, an instrument used for measuring blood pressure, in one room but there was no mercury spill kit on site.
• The practice could not provide proof that all clinicians had received Mental Capacity Act (MCA) and deprivation of liberties (DoLs) training.

The full comprehensive report on the 21 January 2016 inspection can be found by selecting the ‘all reports’ link for Capelfield Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 10 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 21 January 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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

• The practice now had a system in place for the production of Patient Specific Directions.
• The practice no longer stored specimens in the vaccine fridge.
• Printer prescription paper was now stored in a locked cupboard and a system for monitoring it throughout the practice introduced.
• A fire evacuation drill had been carried out and recorded.
• The mercury containing instrument had been removed.
• All clinical staff had received Mental Capacity Act and Deprivation of Liberty training.

Additionally we saw that:

• Staff had been trained in adult safeguarding and basic life support.
• The practice had a recruitment policy in place, but had not employed any new staff since the previous inspection.
• However the procedure for registering a new manager and the regulated activity ‘maternity and midwifery’ had not yet been completed.

The areas where the provider should make improvement are to:

• Ensure that the process to register a manager with CQC is completed.
• Ensure that all regulated activities being provided are registered with CQC including maternity and midwifery.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 April 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.
• 87.8% of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less which was better than the national average of 78%.
• 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.

Updated 27 April 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.
• 78.6% of patients with asthma, on the asthma register, have had an asthma review in the preceding 12 months which was comparable to the national average of 75.4%.
• 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.
• The practice’s uptake for the cervical screening programme was 83.1% which was slightly above the national average of 81.8%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice was able to provide us with data that showed they were achieving 96-98% of the target for initial immunisations and 89-97% for booster immunisations.

Updated 27 April 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.

Updated 27 April 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 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 extended hours appointments between 9am – 12pm every Saturday morning for patients who find it difficult to attend during normal surgery opening times.

Updated 27 April 2016

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

• 92.1% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is above the national average of 84%.
• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months which was better than the national average of 88.5%.
• 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 27 April 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, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• 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.