The Orchard Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Orchard Surgery on 26 May 2016. During this inspection we found breaches of legal requirement and the provider was rated as requires improvement under the safe and well led domains. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for The Orchard Surgery on our website at www.cqc.org.uk. The practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Developing their governance systems in relation to holding regular meetings regarding practice performance and ensuring these are documented and communicated to all relevant staff.

• Ensuring that all recruitment checks are completed in line with their practice policy in relation to obtaining written references prior to employment.

• Ensuring that risk assessments were regularly reviewed and embedded within their practice system.

Additionally we found that:

• The practice needed to continue to monitor their performance in diabetes management to ensure patient outcomes are managed effectively.

This inspection was an announced focused inspection carried out on 2 February 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 26 May 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection..

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice were now holding regular partner, practice and reception meetings and ensuring that these were properly recorded and disseminated to all relevant parties.

• The practice were now complying with their practice recruitment policy and ensuring all relevant employment checks were undertaken before employment started.

• The practice had undertaken the required risk assessment for not having a defibrillator and ensured that all staff had understood its contents.

• The practice had monitored their performance in diabetes management and the latest data showed that improvements had been made.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Orchard Surgery on 26 May 2016. Overall the practice is rated as requires improvement.

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.
• The approach to risk management was not yet fully embedded, for example we saw that risk assessments had taken place very recently for fire risk and legionella risk. We did not see evidence of a risk assessment regarding the location of the defibrillator, however this was provided shortly after the inspection. There was evidence of an increased awareness of the need for thorough risk assessments and follow up action.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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.
• Data from the national GP patient survey showed patients rated the practice higher than others for all aspects of care. The practice was rated as the seventh best practice in Surrey in the latest survey published in July 2016.
• The practice had produced a number of patient information leaflets to help patients understand their condition better.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• The practice had reasonable 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.
• The practice had a number of policies and procedures to govern activity, but some of these had been implemented recently and not all staff were aware of them.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• One of the partners had produced a series of patient education videos explaining common conditions and how to care for these yourself. These were available via links on the practice website.

The areas where the provider must make improvements are:

• Embed and develop further governance systems, for example hold regular meetings and take written minutes to review practice performance and ensure information is communicated to all relevant staff.
• Ensure that references are taken out for all new staff employed in line with the practice policy.
• Ensure that risk assessments are regularly reviewed and embedded into practice systems. 

The area where the provider should make improvement is:

• Continue to monitor performance in diabetes management to ensure patients outcomes are managed effectively.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice