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Inspection carried out on 31 October 2018

During an inspection to make sure that the improvements required had been made

This practice is rated as Good overall.

Ashley Centre Surgery was previously inspected in December 2017 where the practice was rated good overall and good in effective, caring, responsive and well led services. However, we found breaches in regulation for the safe domain and this was rated as requires improvement. We carried out an announced focused inspection on 31 October 2018 to check if the areas of concern had been addressed.

The key question at this inspection is rated as:

Are services safe? – Good

We carried out an announced focused inspection at Ashley Centre Surgery on 31 October 2018. The inspection was to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made from the inspection in December 2017. This report covers our findings in relation to only those requirements found within the safe domain. The full comprehensive reports for the previous inspections can be found by selecting the ‘all reports’ link for Ashley Centre Surgery on our website at .

Our findings were:

  • The practice had effective ways to record actions taken after receiving safety alerts including MHRA alerts.
  • The practice was conducting frequent checks of the general environment and monitoring the cleaning by the external company.
  • The practice had ensured that a COSHH assessment has been completed for cleaning products used.
  • The practice was tracking blank prescriptions forms used throughout the practice.
  • The practice ensured staff had received the appropriate training required which included safeguarding vulnerable adults and children and infection control.
  • The practice ensured that staff who acted as chaperones had a Disclosure and Barring Service (DBS) Check completed.

We also saw evidence that the practice had:

  • Increased the number of carers. At the inspection in November 2017 the practice had 103 registered carers. At this inspection there were 170 carers registered including two young carers. There was also a new carers lead.
  • The practice had contacted the CCG in relation to their clinical waste storage facilities and we saw evidence that a new company was going to be used from January 2019. The practice was in communication with the new company to ensure their previous concerns were addressed before the start of the new contract.
  • We spoke with the practice in relation to their verbal and low level complaints. They told us that the complaints lead reviewed comments on NHS choices and ensured that any comments were reviewed, investigated and replied to. The practice was also in the process of renewing their website and was ensuring that patients could use the website to record any concerns or low level complaints that they had.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 5 December 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

Ashley Centre Surgery was previously inspected in November 2014 and was rated good in all domains and overall.

At this inspection in December 2017 the practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Ashley Centre Surgery on 5 December 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • There was a strong focus on improvement at all levels of the organisation.
  • Data from the Quality and Outcomes Framework (QOF) showed the results for practice management of patients with long-term conditions were good.
  • Information about services and how to complain was available and easy to understand.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • GPs took ownership of all repeat prescriptions requests to ensure patients were receiving correct medicines and had received medicine reviews as necessary.
  • Patients said they were able to book an appointment that suited their needs. Pre-bookable, on the day appointments, home visits and a telephone consultation service were available. Urgent appointments for those with enhanced needs were also provided the same day.
  • The practice was equipped to treat patients and meet their needs.

The areas where the provider must make improvements as they are in breach of regulations are:

Establish effective systems and processes to ensure that care and treatment is provided in a safe way for service users. By:-

  • establishing more effective ways to record actions taken after receiving safety alerts including MHRA alerts.
  • assessing the risk of preventing, detecting and controlling the spread of infections. Including conducting frequent checks of the general environment and the cleaning by the external company and ensuring a COSHH assessment has been completed for cleaning products used.
  • ensuring the safe and proper management of medicines by monitoring blank prescriptions forms throughout the practice.

Ensure persons employed in the provision of the regulated activity receive the appropriate training necessary to enable them to carry out the duties. This includes but is not limited to safeguarding and infection control training.

Ensure that staff are of good character when being used as chaperones by completing a Disclosure and Barring Service (DBS) Check.

The areas where the provider should make improvements are:

  • Consider displaying information available for carers within the waiting areas.
  • Consider ways to identify and support more patients who are carers.
  • Review the agreement with the Clinical Commissioning Group and the clinical waste collection company in supplying adequate clinical waste storage facilities.
  • Consider raising the threshold for the recording of significant events and verbal complaints.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 20 November 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

We undertook an announced comprehensive inspection of Ashley Centre Surgery on the 20 November 2014. The practice has an overall rating of good.

Ashley Centre Surgery provides primary medical services to people living in Epsom. The practice is situated in the town centre. At the time of our inspection there were approximately 9,650 patients registered at the practice with a team of four GP partners. Ashley Centre Surgery is a GP training practice and at the time of the inspection was providing training and support for three registrars.

Our key findings were as follows:

  • GPs took ownership of all repeat prescriptions requests to ensure patients were receiving correct medicines and had received medicine reviews as necessary.
  • Patient feedback about the practice and the care and treatment they received was very positive.
  • Infection control audits and cleaning schedules were in place and the practice was seen to be clean and tidy
  • An active patient participation group was working in partnership with the practice and there was evidence the practice was listening to its patients.
  • The practice had systems to keep patients safe including safeguarding procedures and means of sharing information in relation to patients who were vulnerable.
  • There were a range of appointments to suit most patients’ needs. However, some patients reported difficulty in calling the practice to book appointments and accessing appointments on the same day with their preferred GP.
  • Patients with palliative care needs were supported using the Gold Standards Framework.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice