Townhill Medical Practice - Care Quality Commission

Background to this inspection

Updated 27 June 2017

Townhill Medical Practice is based in a purpose built property in Caterham. The practice has a General Medical Services (GMS) contract with NHS England. (GMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The practice is part of NHS East Surrey Clinical Commissioning Group.

At the time of our follow up inspection there were approximately 12,900 patients on the practice list. The practice has a slightly higher than average number of patients from birth to 19 years and also over 85 years, there is a slightly lower than average number of patients aged 20 to 44 years old. The practice has a higher than average number of female patients aged 11 to 18 years which is due to the practice providing care to the pupils of a girl’s boarding school. The practice also provides care and treatment to one large residential home, three nursing homes and two specialist neurological rehabilitation residential centres. The practice also has a higher than average number of patients with long standing health conditions. Deprivation amongst children and older people is low when compared to the population nationally.

The practice has two GP partners and eight salaried GPs, three of which will join the partnership in July 2017. The GPs are supported by a nurse practitioner, an urgent care practitioner, a specialist nurse, three practice nurses, two healthcare assistants, a phlebotomist, a practice manager, an assistant practice manager and a team of clerical and reception staff. Townhill Medical Practice is a training practice so it takes supernumerary registrars who are qualified doctors completing their specialist training as GPs.

The practice is open between 8am and 6.30pm Monday to Friday. Extended hours appointments are offered 6.30pm to 8pm Monday evening, 6.30pm to 7.30pm Wednesday evening and Saturday morning from 8am to 11am. When the practice is closed patients are advised to call NHS 111 where they will be given advice or directed to the most appropriate service for their medical needs.

The service is provided from the following location:

Townhill Medical Practice, Guards Avenue, Caterham, Surrey CR3 5XL.

Overall inspection

Good

Updated 27 June 2017

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Townhill Medical Practice in Caterham, Surrey on 24 August 2016 we found two breaches of regulation relating to the provision of safe and effective services. The overall rating for the practice was requires improvement. The concerns which led to these ratings applied to everyone using the practice and we rated all population groups as requires improvement. Specifically, the practice was rated requires improvement for the provision of safe and effective services. The practice was rated good for the provision of caring, responsive and well-led services. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Townhill Medical Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 20 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection in August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. Using information provided by the practice we found the practice was now meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. All six population groups have also been re-rated following these improvements and are also rated as good.

Our key findings were as follows:

The practice was now ensuring all patient records were securely held. Electronic access to patient records was now available for all practice clinicians to use in the school and at the nursing homes which the practice provides GP services for.

Training arrangements were consistent; there was now a system to identify when staff had training and when it would need to be refreshed. All staff had completed training appropriate to their job role. For example, all GPs had completed the correct level of safeguarding training appropriate to their job role.

The practice was now operating safe systems in relation to health and safety. The practice had established and was now operating an effective system to assess, manage and mitigate the risks identified relating to the storage of liquid nitrogen.

The practice had revised recruitment policies and processes which reflected national guidance. For example, supporting recruitment documentation which was missing during the August 2016 inspection had now all been recorded and documented correctly including evidence of full employment history for members of staff.

Blank prescription forms and pads were kept securely and tracked through the practice.
The practice had reviewed and updated the practice governance framework. This included a review of health and safety arrangements and supporting policies and procedures.
Following the August 2016 inspection, the practice immediately developed and implemented a system for recording when Deprivation of Liberty Safeguards were in place. The Deprivation of Liberty Safeguards are an amendment to the Mental Capacity Act 2005. The Mental Capacity Act allows restraint and restrictions to be used – but only if they are in a person's best interests.
Further steps had been taken to monitor patient satisfaction including a survey completed in February 2017. This survey involved the patient participation group (PPG) and specifically reviewed patient satisfaction regarding telephone access to the practice.
Following a review of the management of diabetes within the practice population, improvements had been made including completed diabetic audits and the appointment of a special diabetes nurse. These actions had strengthened how the practice managed diabetes ensuring these patients received appropriate care and treatment.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice