You are here

Inspection Summary


Overall summary & rating

Good

Updated 19 February 2015

Letter from the Chief Inspector of General Practice

On 24 October 2014 we carried out an announced comprehensive inspection of Market Square Surgery, Waltham Abbey, Essex under our new approach of inspection of primary medical services.

We found that the practice was good across all the key areas we looked at and patients expressed a high level of satisfaction about the way the services were provided.

Our key findings were as follows:

  • The practice had systems and processes in place that made the practice safe for both patients and staff.
  • Staff were kind and caring and dedicated to providing high quality care and treatment. Patients privacy and dignity was maintained.
  • The practice were aware of the needs of their patients and tailored services to meet them
  • The practice worked well with other health care providers to achieve effective outcomes for their patients. Information sharing and communication with partner agencies helped support the levels of care and treatment received by patients.

However, there were also areas of practice where the provider should make improvements.

The provider should:

  • The practice should undertake a Health and Safety Risk Assessment to ensure staff and patients are safe.

  • The practice should ensure staff are suitably trained in fire emergency procedures and that fire drills are practised at appropriate intervals.

  • The practice should review their repeat prescription system to ensure patients receive a regular review of their medicines.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Updated 19 February 2015

The practice is rated as good for safe. The practice had systems in place that demonstrated they were a safe practice and had sustained this over time but some improvements were required. Sufficient numbers of staff had been trained in safeguarding children and vulnerable adults and whistle blowing and all were aware of the different signs of abuse. A safeguarding lead had been appointed who had been suitably trained. Where any safety issue had been identified or reported, they had been investigated and areas for improvement identified. Team meetings and other formal notifications to staff ensured they were aware of any learning to prevent a reoccurrence. Staffing levels were monitored, processes were in place to manage emergencies and infection control procedures were satisfactory. Fire procedures required reviewing in conjunction with other users of the building. The recruitment procedure was not clear about which roles required Disclosure and Barring Service checks. There was an absence of a Health and Safety Risk Assessment to keep staff and patients safe.

Effective

Updated 19 February 2015

The practice is rated as good for effective. Patients had their needs assessed in line with published guidance and the practice worked closely with other health care providers to achieve effective outcomes for patients. An effective system was in place to refer patients to specialists and recordswere updated with the outcomes of those consultations. Health care promotion took place through health checks and the provision of information to help people live healthier lives or manage their conditions. Patient reviews took place to ensure treatment and medicines were effective. Staff understood consent requirements and supported patients when necessary. Staff received appraisals, development opportunities and were supported in the workplace. Performance across key health care objectives were being monitored regularly to ensure the patient population received the best outcomes.

Caring

Updated 19 February 2015

The practice is rated as good for caring. Patients were satisfied with the way they were treated and thought staff were kind and caring. Privacy and dignity was respected and patient confidentiality maintained. Patients received clear explanations from clinical staff and were involved in their care and treatment. Where care plans were required, these had been discussed with the patient and their relatives, if applicable. A range of health care literature was available in reception and on the practice website which provided information for patients and signposted them to support services.

Responsive

Updated 19 February 2015

The practice is rated as good for responsive. Patients told us that appointments were readily available but that on some occasions it was difficult to get an appointment time of their choice. Where there was an urgent need, they could see a GP, receive a home visit or phone consultation on the same day. Older patients had a named GP who had responsibility for the oversight and coordination of their care. Patients could see their preferred GP when they were available and had a choice of a male or female doctor. An effective complaints system was in place, understood by all staff and learning opportunities were identified and acted upon. Information was available to patients in leaflet form at reception. The practice was readily accessible to patients who had a disability or those with limited mobility.

Well-led

Updated 19 February 2015

The practice is rated as good for well-led. A clear leadership structure was in place and designated leads had been identified for key roles. All staff were aware of their individual responsibilities. Audits had been undertaken to monitor and assess the quality of the services provided and staff and patients were asked for feedback about the way the practice was managed. Regular staff meetings took place. Where areas for improvement had been identified these were followed up with an action plan and then monitored until completion.

Checks on specific services

Older people

Good

Updated 19 February 2015

The practice is rated as good for older people. Patients over 75 had a named GP who was responsible for the oversight and coordination of their care. Care plans were in place for older people with complex needs. GPs and other health care professionals worked together in a multi-disciplinary way to provide the best care and treatment and to reduce unplanned hospital admissions. Care and treatment was personalised and met the needs of older people. Dementia screening took place to try and identify those patients showing signs of the illness so they could be referred to specialists early to enable them to receive support and treatment to help them manage the condition. The appointment system reflected the needs of the elderly. Telephone consultations and home visits were available if necessary and older patients were given priority. An effective flu vaccination programme was in place.

People with long term conditions

Good

Updated 19 February 2015

The practice is rated as good for people with long-term conditions. Patients with long-term conditions received regular health checks from a GP and were offered and signposted to support organisations to help them manage and understand their condition. Appointments with the nurse and health care assistant were readily available so that patients could be monitored. The practice worked with other health care providers for patients with complex needs through a multi-agency approach and regular meetings.

Families, children and young people

Good

Updated 19 February 2015

The practice is rated as good for families, children and young people. There was an effective system in place to safeguard children from abuse through the use of a register identifying vulnerable patients. Staff had been trained in safeguarding and were able to identify the different signs of abuse. Mothers and babies could access postnatal and antenatal support from the Nurse and Health Care Assistants. The practice followed immunisation guidance for young babies and children and these were effective. Young people were able to book appointments without a parent being present, subject to satisfying GPs of their ability to understand the care and treatment suggested.

Working age people (including those recently retired and students)

Good

Updated 19 February 2015

The practice is rated as good for working age people. The appointment system met the needs of these patients. A late evening surgery was available one day each week for working people or those who could not attend during the day. Daytime appointments could be booked on the same day or the next day. The practiced promoted healthy living and appointments were available with the practice nurse for lifestyle advice. This included smoking cessation and alcohol advice designed to prevent ill health in the future. The student population was encouraged to register at the practice as temporary residents.

People whose circumstances may make them vulnerable

Good

Updated 19 February 2015

The practice is rated as good for people whose circumstances may make them vulnerable. A register was maintained of patients with learning disabilities and they were invited to attend an annual review or more frequently if considered necessary. A double appointment was made available to them to ensure their needs were covered. Carers of those living in vulnerable circumstances were identified and offered support including signposting them to external agencies. The practice had a travelling community nearby and a number of refugees as patients. Information and registration packs were available for these groups when registering at the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 February 2015

The practice is rated as good for people experiencing poor mental health. A nurse trained in mental health worked at the practice for one day each week. Suitable patients were referred to her for support and counselling. Timely referrals were made to specialists after a dementia diagnosis so early medical intervention could be achieved. Patients who were diagnosed with dementia were then included on a register and their condition monitored after discharge from a specialist.