The Care Quality Commission
  • Doctor
  • GP practice

Chalfont Surgery

Overall: Good read more about inspection ratings

1 Smythe Close,, London, N9 0TW (020) 8807 4505

Provided and run by:
Enfield Healthcare Alliance Limited

All Inspections

During an assessment under our new approach

Chalfont Surgery is a GP practice that delivers services to approximately 6,200 patients under a contract held with NHS England. National GP profiles state the ethnic makeup of the practice area is 38.9% White, 12.6% Asian, 28.5% Black, 5.2% Mixed and 14.6% Other. Information published by the Office for Health Improvement and Disparities shows that the deprivation within the practice population is in the 2nd decile of 10. The lower the decile, the more deprived the practice population is relative to others. This assessment considered the demographics of the people using the service, the context the service was working in and how this impacted service delivery. Where relevant, further commentary is provided in the quality statement section of this report.

People and staff were kept safe and protected with incidents and complaints investigated. Learning outcomes were discussed. There was a robust Infection Prevention and Control (IPC) system with regular audits. Staff received regular training and appraisals. Staff managed medicines well and involved people in planning and changes.

People were involved in assessments of their needs. Regular health checks and reviews took place. Evidence based care in line with good practice was delivered. The service worked with other agencies to enable good outcomes of care. People made informed decisions about their health.

People were treated with kindness and compassion. Dignity and privacy were respected. A chaperone service was provided to those who requested it.

People were involved in decisions about their care and information needed to make a decision was provided. Interpretation services were available. Complaints were handled appropriately.

Leaders and staff had a shared vision and culture. Leaders understood equality, human rights and safe compassionate care. Staff understood their roles and responsibilities.

The provider was previously inspected in 2018 under our old methodology and was rated good.

18 January 2018

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection which took place at the former Chalfont Road surgery in September 2017 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Chalfont Surgery on 18 January 2018. This was part of our inspection programme. The practice was previously called Chalfont Road Surgery and had recently relocated to the Evergreen Health Centre and changed name to Chalfont Surgery. Chalfont Road Surgery was previously rated good.

At this inspection we found:

  • There had been a successful transition from Chalfont Road to the Evergreen Health Centre with patients providing positive comments around the move.
  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • The results of the national GP patient survey showed that patients were satisfied with the practice. However some results were below the national average and the practice had produced an action plan to address these.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with 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 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.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvements are:

  • To review the national patient survey results and to monitor and implement improvement activities.

  • To review current practice systems for the cervical screening programme with a view to improving the current uptake.

  • Review how patients with caring responsibilities are identified and recorded on the patient record system to ensure information, advice and support is made available to all.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice