Mansion House Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mansion House Surgery 25 August 2015. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Some risks to patients and staff were not assessed and systems and processes were not fully implemented to keep patients safe. For example, there were no assurance systems in place to confirm cleanliness and infection control procedures were effective. Small patches of damp were evident in the building.
• Staff appraisals were not up to date for all staff groups
• Although some clinical audits had been carried out, we saw no evidence that audits were planned effectively or driving improvement in performance to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available on request and easy to understand; however this was not as readily accessible to patients as it could have been.
• Urgent appointments were usually available on the day they were requested; however patients said that they sometimes had to wait a long time for non-urgent appointments.
• The practice had a number of policies and procedures to govern activity and held regular scheduled meetings for all staff groups
• The practice had sought feedback from patients but did not have a patient participation group or website and was not included on the NHS Choices website.
• The practice did not have a documented vision or business plan for the future; however they had identified some of the challenges faced. There was a leadership structure and staff felt supported by management. However, some of the systems and processes which should have been in place to keep patients and staff safe were not established.
• The practice had been instrumental in the development of a Community Nursing scheme to ensure more co-ordinated care in the community for older patients. Although this was a clinical commissioning group (CCG) incentive the practice had been proactive in developing and piloting the scheme.
• The practice had employed a care co-ordinator to support elderly, frail and palliative care patients
• The practice hosted an on-site ultrasound and 24 hour ECG facility for the clinical commissioning group.

We saw one area of outstanding practice:

• The practice had employed a care coordinator whose role was to ensure that appropriate care and support was in place for frail and elderly patients and those with dementia   

However, there were areas of practice where the provider needs to make improvements.

Importantly the provider must:

• Ensure that all staff are given the opportunity to have a regular appraisal.

In addition the provider should:

• Review the process for identifying, carrying out and reviewing areas for clinical audit.
• Continue with their plans to set up a patient participation group and practice website.
• Develop a business plan to reflect and record aims, objectives, risk and mitigating actions.
• Put in place appropriate arrangements to maintain a clean environment and assess the risk, detect, prevent and control the spread of infections by carrying out regular infection control audits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice