Archived: Gosford Green Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gosford Green Surgery on 16 May 2017. As a result of our inspection the practice was rated as good overall but required improvement for providing safe services. The full comprehensive report on the May 2017 inspection can be found by selecting the ‘all reports’ link for Gosford Green Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based focused inspection carried out on 16 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 16 May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

• The practice had introduced a pathway and written guidance to ensure that all staff were aware of the correct procedure to follow when reviewing letters from the hospital that indicated changes in medicines. They had also carried out an audit to evidence that all staff had correctly adhered to the process since its implementation.
• The practice had a system and policy for reporting significant events but had reviewed and enhanced this to encourage staff to consider more topics for significant event reporting.
• The practice had replaced missing items and ensured that emergency medicines and equipment included all necessary items recommended for use in an emergency.
• The National Patient Survey results published in July 2017 showed that the patient satisfaction was higher in most areas than the previous survey had reported and indicated improvement had been made. Generally the practice results were now comparable to the Clinical Commsioning Group (CCG) and national averages.
• The practice had obtained posters advertising national screening and had placed these in the waiting area to encourage patient uptake. Bowel screening was also promoted on the practice health promotion television screen in the waiting area. The practice told us that clinical staff were also reminding eligible patients opportunistically during consultations of the importance of screening.

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 Gosford Green Surgery on 16 May 2017. Overall the practice is rated as good.

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

• There was a suitable policy and an incident reporting form which all staff were able to access on the practice’s computer system. All incidents were discussed during monthly practice meetings and learning outcomes were recorded. The practice had only recorded three significant events during the previous 12 months.
• The arrangements to safeguard children and vulnerable adults from abuse met local requirements and current legislation. Staff we spoke with were aware of their safeguarding responsibilities and knew how to access policies and escalate concerns about patients’ welfare.
• The GP did not always review discharge letters, but had a member of non-clinical staff operating as a prescription clerk to make any prescription changes directed by the hospital.
• The practices emergency medicines box did not contain one essential emergency medicine. The practice had ordered this prior to the inspection and explained that there had been a supply issue, and an alternative medicine had been stocked as an interim measure. We also noted that some of the practice’s intubation equipment and some of the dressings in the first aid kit had passed expiry date or the packaging did not show any expiry date.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were in line with or above CCG and national averages, except for in breast and bowel cancer screening where they were lower.
• Staff had the skills, knowledge and experience to deliver effective care and treatment. All staff had received a combination of external, in-house and online training.
• Results from the national GP patient survey published in July 2016 were mixed. The practice was in line with or above averages for its satisfaction scores in some areas, but below average for clinical consultations. Patient feedback we gathered during the inspection described the practice as friendly and helpful, and the GP as approachable and professional.
• The practice offered extended hours appointments until 8pm every Monday, and telephone consultations daily for patients who had difficulty in attending the practice during opening hours.
• The practice had led an awareness campaign to reduce appointment wastage and make the appointment system more efficient. This resulted in a significant reduction of appointments not attended.
• The practice’s complaints policy and procedures were in line with recognised guidance and contractual obligations for GPs in England.
• The practice had modern facilities and was well equipped to treat patients and meet their needs.
• The practice governance arrangements supported the delivery of its future plans and inspired good quality care. We observed that staff worked well together and they told us they felt valued by the practice and able to contribute to its development.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Take action to ensure that all proposed changes to prescriptions directed by the hospital are reviewed by the GP prior to prescriptions being issued.

In addition the provider should:

• Ensure that emergency equipment such as dressings and intubation is fit for use.
• Ensure the supply of emergency medicines is maintained.
• Encourage patients to engage with national breast and bowel cancer screening programmes.
• Continue to encourage reporting of incidents and significant events.
• Continue to review patient satisfaction results for consultations with GPs and nurses and take measures to improve these.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice