The Care Quality Commission
  • Doctor
  • GP practice

Attenborough Surgery

Overall: Good read more about inspection ratings

Bushey Medical Centre, London Road, Bushey, Hertfordshire, WD23 2NN (01923) 231633

Provided and run by:
Attenborough Surgery

All Inspections

18 and 19 January 2023

During an inspection looking at part of the service

We carried out an announced focused inspection at Attenborough Surgery on 18 and 19 January 2023. Overall, the practice is rated as good.

The ratings for each key question are:

Safe - requires improvement

Effective - good

Caring – not inspected, the rating of good is carried forward from our previous inspection

Responsive – good

Well-led – good.

Following our previous inspection on 19 November 2019, the practice was rated good overall and for the provision of effective and well-led services. The practice was rated requires improvement for the safe key question.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Attenborough Surgery on our website at www.cqc.org.uk.

Why we carried out this inspection

We inspected Attenborough Surgery as part of our regulatory functions under the Health and Social Care Act 2008.

We served a requirement notice following our previous inspection as we found there were breaches in regulation 12 (safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We carried out this inspection to follow up on the concerns identified in the safe key question, the breaches of regulation and the areas identified where the provider should make improvements.

We looked at the safe, effective, responsive and well-led key questions for this inspection.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • conducting staff interviews using video conferencing facilities

  • completing clinical searches and reviewing patient records on the practice’s patient records system to identify issues and clarify actions taken by the provider

  • requesting evidence from the provider

  • a site visit to Attenborough Surgery including all 4 of the practice’s sites

  • requesting and reviewing feedback from staff and patients who work at or use the service.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected

  • information from our ongoing monitoring of data about services

  • information from the provider, patients, the public and other organisations.

We found that:

  • The practice had made improvements to provide care in ways that kept patients and staff protected from avoidable harm, for example in processes to ensure emergency medicines and equipment were always safe and available to use.

  • Staff worked together and with patients and other organisations to deliver effective care and treatment and help patients to live healthier lives.

  • The practice organised and delivered services that met patients’ needs.

  • There was effective leadership and a positive culture in the practice.

  • The practice sought and responded to feedback from patients and staff to continue to make improvements.

  • There was a strong learning environment and a desire to continue to improve the quality of the service and apply innovative ways of working to support patients and staff.

We also saw an area of outstanding practice in how the practice worked with other services to to provide coordinated and responsive care for patients with complex mental health needs.

Whilst we found no breaches of regulations, the provider should:

  • Continue to take actions to check all staff continue to be suitable for their roles, including, but not limited to, checks that staff have appropriate and up-to-date Disclosure and Barring Services checks, appraisals and that staff have completed all required training, for example in basic life support.

  • Continue to develop systems to maintain health and safety requirements at all of the practice’s sites, for example fire drills, checks of the fire alarm systems and water testing for legionella bacteria.

  • Continue to monitor and take actions to improve attendance for cervical screening.

  • Monitor and review all patients who have medicines or long-term conditions in line with national guidance and to protect patients affected by safety alerts from harm.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

19 November 2019

During an inspection looking at part of the service

We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

This inspection focused on the following key questions: safe, effective and well-led.

Because of the assurance received from our review of information we carried forward the ratings for the following key questions: caring and responsive.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected,
  • information from our ongoing monitoring of data about services and,
  • information from the provider, patients, the public and other organisations.

We have rated this practice as good overall.

We rated the practice as requires improvement for providing safe services because:

  • Appropriate standards of cleanliness and hygiene were not always met because some infection prevention and control measures were lacking.
  • The practice’s systems for the appropriate and safe use of medicines, including medicines optimisation, were not always comprehensive.
  • The system for acting on safety alerts was not comprehensive.
  • Although not part of the requirement notice due to the practice’s immediate actions or the level of concern, there were some issues that contributed to the requires improvement rating for the safe key question. They included those relating to: DBS checks, staff awareness of the process for following up children who were regular attenders of accident and emergency (A+E) departments, staff vaccinations, Legionella risk assessment, and the monitoring and security of prescription stationery.

Please see the final section of this report for specific details of our concerns.

We rated the practice as good for providing effective and well-led services because:

  • Patients received effective care and treatment that met their needs. The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • The way the practice was led and managed promoted the delivery of high quality, person-centred care and an inclusive, supportive environment for staff. There was a focus on continuous learning and improvement at all levels of the organisation. Where we identified any concerns during our inspection, the practice took action to respond or plans of action were developed to ensure any issues were resolved.

The area where the provider must make improvements is:

  • Ensure care and treatment is provided in a safe way to patients.

Please see the final section of this report for specific details of the action we require the provider to take.

The areas where the provider should make improvements are:

  • Continue to strengthen policies, systems and processes at the practice. Especially those in relation to following up children who are regular attenders of accident and emergency (A+E) departments, Legionella risk assessment, water temperatures, the monitoring and security of prescription stationery, and encouraging women to attend for their cervical screening and patients to engage in national cancer screening programmes.
  • Implement a comprehensive system of staff related processes to include all staff receiving the required vaccinations, an annual appraisal, completing all essential training at the appropriate level for their roles, completing a Disclosure and Barring Service (DBS) check where required and staff being provided with access to a Freedom to Speak Up Guardian.
  • Make information about the complaints process and procedure readily available and accessible throughout the practice and on the practice’s website.
  • Develop a targeted and coordinated approach to engage with hard to reach communities, including providing health education and promotion materials and practice communications in formats they’d more easily understand.
  • Take steps so the programme of clinical audit regularly results in demonstrable improvement to the care provided to patients.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

18 January 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Attenborough Surgery on 18 January 2017. Overall the practice is rated as good.

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 practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • The patients we spoke with or who left comments for us were positive about the standard of care they received and about staff behaviours. They said staff were courteous, efficient, supportive and professional. They told us that their privacy and dignity was respected and they were involved in their care and decisions about their treatment.
  • Information about services was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Most patients were positive about access to the practice and appointments. Some patients said getting an appointment in advance could be difficult and there could be a considerable wait to see a GP of their choice when making a pre-bookable appointment. However, those patients said access to urgent and same day appointments was good.
  • 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 sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw an area of outstanding practice:

  • The practice demonstrated an overarching approach to continuous quality improvement. For example, members of staff at the practice had received a NHS innovation award for their work on responsible antibiotic prescribing in primary care (specifically in the management of acute lower respiratory tract infection). During the study/trial period we saw that the prescribing of antibiotics on patients’ initial presentation reduced from 31% in the winter of 2014/2015 to 8% in the same three month period during the winter of 2015/2016. Unscheduled follow ups within 28 days for patients who were not prescribed antibiotics reduced by more than 50%. Due to its success, funding was available for the work to spread across the locality and nationally and this was ongoing at the time of our inspection.

The areas where the provider should make improvements are:

  • Ensure that hand wash facilities at Prestwick Road Surgery meet the required specifications.
  • Take steps to ensure that hot water temperatures at the practice are kept within the required levels and a comprehensive water temperature checking process is in place.
  • Ensure that all staff employed are supported by receiving appropriate supervision and appraisal and are completing the essential training relevant to their roles, including safeguarding adults, infection prevention and control and basic life support training.
  • Continue to take steps to ensure that in future National GP Patient Surveys the practice’s areas of below local and national average performance are monitored and improved, including access to appointments.
  • Ensure that at Prestwick Road and Carpenders Park surgeries patients have access to a range of information about the services available, health promotion and access to advice and support groups.
  • Continue to identify and support carers in its patient population.
  • Ensure that all staff are engaged with the development and direction of the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

11 February 2014

During a routine inspection

During our inspection we spoke with six patients and six members of staff.

Patients told us they were spoken with respectfully by staff. A patient told us: "Everybody is extremely polite, pleasant and helpful. I have never had a problem." Patients said that staff ensured their privacy was respected when they needed an examination.

We saw that patients' views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. The patients we spoke with provided positive feedback about their care. A patient said: "One of the doctors' has been amazing." Patients received their medicines when they needed them.

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to so that patients were protected from harm.

We found that staff had received appropriate training for the roles they carried out. They also had regular appraisals. This meant that they had been adequately assessed regarding their competency.

The provider had a system in place for monitoring the quality of service provision. There was an established system to regularly obtain opinions from patients about the standards of the services they received. This meant that on-going improvements could be made by the practice staff.