Archived: Moulsham Lodge Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Moulsham Lodge Surgery on 05 August 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances, and people experiencing poor mental health (including people with dementia).

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed but their assessments would benefit from further development.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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 they were able to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.

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

Importantly the provider should

• Ensure records are maintained for all meetings held.
• Ensure cleaning records are maintained and reflective of the cleaning undertaken.
• Ensure risk assessments are reflective of current risk. Where issues have been identified the provider should record who has been assigned actions, timescales for completion and when the task had been completed.
• Take steps to provide all staff with fire safety and evacuation training

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice