Archived: North Camp Surgery

Updated 26 November 2015

North Camp Surgery, 2 Queens Road, Farnborough, Hampshire, GU14 6DH is a converted dwelling that was extensively extended in 2001. The practice is located on the outskirts of Farnborough. The practice covers a diverse community incorporating a large proportion of ethnic minorities, including people of Nepalese decent. Within the area there are pockets of deprivation. A number of people working for the armed forces are registered with the practice. The practice is on the ground floor with disabled access.

Care and treatment is provided by four GPs, comprising of two male partners, a salaried female GP and a male locum GP.

At the time of our inspection, one of the partners was not working any sessions as a GP and the other partner had reduced the number of weekly sessions down to three.

The practice has around 4,600 patients and operated under a personal medical services (PMS) agreement. The practice manager started working at the practice in August 2015 and the practice had recently employed new administration and reception staff.

Over the previous year the practice has seen a significant amount of change, instability and a lack of clear leadership and management.

The practice offered a proportion of pre-bookable appointments available four weeks in advance. Book-on-the-day appointments were available on a first come basis. Patients could ring from 8.00am for morning appointments and 2.00pm for afternoon appointments. The practice also provided telephone consultations. GP surgeries ran Monday to Friday from 8.30am until midday and from 2.30pm until 6.00pm. The practice had two telephone lines which helped to make it easier for patients to contact the practice. There were extended hours on Tuesdays until 7.30pm and once a month on a Saturday. Out of Hours urgent medical care was provided by Frimley Out of Hour’s service when the practice was closed.

At the time of our visit the practice had been required by NHS England to not carry out any immunisations until the outcome of an investigation. This investigation had been completed and the practice was being supported by North East Hampshire and Farnham CCG to recommence the provision of immunisations within the practice.

Updated 26 November 2015

Letter from the Chief Inspector of General Practice

We carried out an unannounced focussed, follow up inspection of North Camp Surgery, Queens Road, Farnborough, Hampshire GU14 6DH on 15 September 2015.

Our previous inspection in May 2015 had found the practice was requires improvement overall. Due to breaches of regulations relating to safe delivery of services and services being well-led. The practice was good for Effective, Caring and Responsive services.

From the inspection 15 September 2015 the practice is still rated as requires improvement overall. With requires improvement for the provision of safe and effective services. The practice is rated as inadequate for well-led services. The practice remains rated as good for the provision of caring and responsive services. In addition we had received information of concern from NHS England (national commissioning board and contract holder for GP practices) in relation to patients being placed at risk. These concerns referred to inconsistent patient record keeping and a high turnover of staff.

Key findings include:

• The practice was not operating safe systems in relation to the recruitment of staff between May 2015-August 2015.

• There was an inconsistent application of current clinical guidelines documented within patient records.

• There was a lack of governance and management of the practice by those with the authority to make decisions.

However we found the practice had made improvements since our last inspection in May 2015. Specifically the practice was:

• Monitoring hygiene and infection control, including a system of audit, identifying and assessing any risk of legionella.

• Managing risk, assessments were in place and up to date for health and safety such as assessments relating to the premises and equipment.

• Providing appropriate staff with chaperone training and the practice provided a chaperone service for patients in a timely way that does not delay any assessment or treatment needed.

• Ensuring all new staff was performing their roles as needed and supported to have further development.

• Ensuring the practice had arrangements to deal with emergencies with a revised and updated business continuity plan and an automated external defibrillator (AED) in place.

• Securely handling blank prescription forms consistently in accordance with national guidance.

There were areas of practice where the provider needs to make improvements. Importantly, the provider must:

• Ensure all patient records are accurate and up to date.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Ensure there is clear leadership structure, sufficient leadership capacity and formal governance arrangements.

Where a practice is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected within six months after the report is published. If after re-inspection it has failed to make sufficient improvement and is still rated as inadequate for any key questions or population group we will place into special measures. Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 July 2015

The practice is rated as requires improvement 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.

However the practice had recently had to employ a locum nurse after the practice nurse and health care assistant left. This meant that at the time we visited the practice there was difficulty in coping with the needs of patients.

Updated 16 July 2015

The practice is rated as requires improvement 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 accident and emergency (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.

However at the time of our inspection the practice had been required to stop immunisation of patients by NHS England . NHS England was developing a plan to enable vaccinations and immunisations to be delivered at other practices in the area.  

Updated 16 July 2015

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

Care and treatment of older people did not always reflect current evidence-based practice. Nationally reported data showed that outcomes for patients for conditions commonly found in older people were mixed.

Longer appointments and home visits were available for older people when needed, and this was acknowledged positively in feedback from patients.

The leadership of the practice had started to engage with this patient group to look at further options to improve services for them.

Updated 16 July 2015

The practice is rated as requires improvement 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.

Updated 16 July 2015

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

The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health but not always those with dementia. It 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 including MIND and SANE.

It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Most staff had received training on how to care for people with mental health needs.

Updated 16 July 2015

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

The practice held a register of patients living in vulnerable circumstances including homeless people, with a learning disability. The practice had been able to give annual check-ups to 21 of 22 patients registered with the practice who had learning disabilities.

The practice worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.

Most staff knew how to recognise signs of abuse in vulnerable adults and children. Most 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.

The practice had responded to the needs of an increasing Nepalese population group by employing a Nepalese speaking receptionist. Two of the GPs could also speak Nepalese.