Littleton Surgery

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Littleton Surgery on 14 October 2015. We visited the practice location at Buckland House, Esher Park Avenue, Esher, Surrey, KT10 9NY.

Overall the practice is rated as requires improvement. Specifically, we found the practice to be inadequate for providing well led services. The practice required improvement for providing safe, effective and caring services. The practice was also rated as requires improvement for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia). It was good for providing a responsive service.

The practice was subject to a previous comprehensive inspection on 26 November 2014. The practice was rated inadequate for providing well led services, requires improvement for providing safe, effective and responsive services and good for providing caring services. Following the comprehensive inspection on 26 November 2014, the practice sent us an action plan detailing what they would do to meet the regulations. We undertook this comprehensive inspection on 14 October 2015 to check that the provider had followed their action plan and to confirm that they now met the regulations.

Our key findings at this inspection were as follows:

• There was a highly flexible range of appointments to suit most patients’ needs. Patients reported good access to the practice and a named GP or GP of choice, with urgent appointments available the same day.
• The practice engaged effectively with other services to ensure continuity of care for patients. However, information relating to vulnerable adults and children was not routinely shared with Out of Hours services.
• Patient feedback showed that patients did not always feel they were involved in making decisions about their care and did not always have trust or confidence in their GP.
• The practice had improved their recording of significant events, incidents and complaints since our last inspection. However, these were not always reviewed as a team in order to ensure learning and promote continuous improvement.
• There was a lack of effective communication within the management team which meant that information and concerns were not shared and reviewed.
• Risks to staff and patients were not always assessed and managed to ensure they were minimised.
• Care plans for patients identified at high risk of unplanned hospital admission had not been reviewed since our last inspection visit and were not scanned into the practice’s electronic system.
• The practice had not ensured the safe and secure storage and distribution of prescription pads.
• There was a lack of completed clinical audit cycles, review of patient treatment outcomes and use of patient feedback to ensure continuous improvement.
• Appropriate recruitment checks on staff had not been undertaken prior to their employment.
• Staff felt well supported and had received key training appropriate to their roles since our last inspection. Further training needs had been identified and planned. Staff had received regular appraisal of their performance.
• Information about how to make a complaint was available and easy to understand.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure risk assessment and monitoring processes effectively identify, assess and manage risks relating to fire safety and evacuation procedures, the safe storage of archived, paper-based patient records and the management of medical emergencies.
• Ensure clear processes for the review and learning from incidents, significant events and complaints in order to promote continuous improvement and the health, safety and welfare of patients and staff.
• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Ensure audit cycles are fully completed in order to demonstrate actions taken have enhanced care and resulted in improved outcomes for patients.
• Ensure regular review of patient treatment outcomes to ensure continuous improvement, particularly in relation to childhood immunisations and cervical screening.
• Ensure care plans for patients at risk of unplanned hospital admission are reviewed and updated records are held electronically.
• Ensure information relating to vulnerable adults and children is routinely shared with Out of Hours services.
• Ensure the security and tracking of blank prescription pads at all times.
• Ensure all staff have access to appropriate policies and guidance to carry out their role and which reflect practice processes.
• Ensure the regular review of patient feedback, particularly to improve upon the level of patient dissatisfaction surrounding consultations with GPs.

In addition the provider should:

• Ensure all information available to patients on the practice website and in the practice booklet is up to date.
• Ensure all nurses and GPs complete training in the Mental Capacity Act 2005 as planned.
• Ensure that the practice partnership registration with the Care Quality Commission accurately reflects the partnership status.

I am placing this practice in special measures. Where a practice is rated as inadequate for one of the five key questions or one of the six population groups and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration. Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice