Archived: Lantern Surgery

Updated 23 April 2015

Lantern Surgery provides primary medical services to 4,300 registered patients. The practice delivers services to a higher number of patients who are aged 65 years and over, when compared with the local clinical commissioning group (CCG) and England average. Data available to the Care Quality Commission (CQC) shows fewer of the registered patients suffering income deprivation than both the local and national average.

Care and treatment is delivered by two GP partners and two salaried GPs. At the time of inspection, one of the GP partners had recently announced their retirement and was due to leave the practice. There is a mix of male and female GPs. The practice employs a team of two practice nurses and a healthcare assistant. GPs and nurses are supported by the practice manager and a team of reception and administration staff. The practice has not been subject to a previous inspection.

The CQC intelligent monitoring placed the practice in band 3. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

Services are provided from:

Lantern Surgery

3 Station Approach

Hinchley Wood

Esher

Surrey

KT10 0SP

The practice has opted out of providing out of hours services to its own patients and uses the services of a local out of hours service.

Updated 23 April 2015

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Lantern Surgery on 18 November 2014. We visited the practice location at 3 Station Approach, Hinchley Wood, Esher, Surrey, KT10 0SP.We have rated the practice as requires improvement. Specifically, we found the practice to require improvement for providing safe, effective and well led services. The concerns which led to these ratings apply to everyone using the practice, therefore the different population groups are also rated as requires improvement. The practice was good for providing a caring and responsive service.

The inspection team spoke with staff and patients and reviewed policies and procedures implemented throughout the practice. The practice was responsive to the needs of the local population and engaged effectively with other services.

Our key findings were as follows:

• There was a 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.
• Patient feedback showed that patients felt they were involved in making decisions about their care and were treated with kindness and respect.
• Staff told us there was an open culture within the practice and they felt well supported in their roles.
• Staff had not always received training in mandatory areas.
• Risk assessment and monitoring processes were not always in place to ensure the safety of patients and staff.
• Staff did not always have access to clear written guidance to support them in carrying out their role.

The areas where the provider must make improvements are:

• Ensure all staff are supported by means of appraisals and personal development plans.
• Ensure that all staff are trained in safeguarding of children and vulnerable adults and infection control processes.
• Ensure all staff have appropriate policies, procedures and guidance to carry out their role. This includes providing staff with policies for safeguarding vulnerable adults and infection control processes.
• Ensure recruitment processes include all required pre-employment checks in order to minimise the risks to the health, safety and welfare of patients.
• Ensure risk assessment and monitoring processes effectively identify, assess and manage risks relating to the health, safety and welfare of patients and staff, including fire safety, the risk of exposure to legionella bacteria and to support decisions relating to which staff roles require criminal records checks.

In addition the provider should:

• Establish a process to ensure more formal sharing of information and encourage continuous learning and improvement of all staff.
• Ensure adequate arrangements to cover staff absence in order to meet the needs of all patients, including the support and review of patients with long term conditions.
• Ensure appropriate consent is recorded from patients undergoing minor interventions such as joint injections.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 April 2015

The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as requires improvement for safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as requires improvement for the care of patients with long term conditions.

When needed longer appointments and home visits were available. These patients had structured annual reviews to check their health and medicine needs were being met. The GPs followed national guidance for reviewing all aspects of a patient’s long term health. The practice nurses were trained and experienced in providing diabetes and asthma care to ensure patients with these long term conditions were regularly reviewed and supported to manage their conditions. However, the long term absence of one member of the team meant that annual reviews of some patients with long term respiratory conditions had been delayed and were still overdue. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Patients with palliative care needs were well supported. The practice worked closely with the local hospice and two local residential homes.

Updated 23 April 2015

The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as requires improvement for safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as requires improvement for the care of families, children and young patients.

Appointments were available outside of school hours and the practice ensured that children needing an urgent appointment would be seen the same day. The premises were suitable for children and babies. There was good communication and collaboration between the practice and other services including midwives, health visitors and support organisations. Monthly meetings between the practice and the health visitor enabled them to share concerns when they arose. The practice had safeguarding processes to protect children from abuse. Staff were aware of the process and had some understanding of what action to take if they suspected abuse or had concerns. However, many staff had not received training in the the safeguarding of children.

Updated 23 April 2015

The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as requires improvement for safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as requires improvement for the care of older patients.

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older patients. The practice offered proactive, personalised care to meet the needs of the older patients in its population. The practice was responsive to the needs of older patients, including offering home visits and same day appointments for those with enhanced needs. Older patients with complex care needs had personalised care plans that were shared with other services to facilitate the continuity of care. The practice had some safeguarding processes to protect vulnerable adult patients from abuse but there was no written policy to support staff. The majority of staff had not received training in the safeguarding of vulnerable adults. A chaperone service was available to all patients.

Updated 23 April 2015

The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as requires improvement for safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as requires improvement for the population group of working-age patients (including those recently retired and students).

The needs of the working age population, those recently retired and students, had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. Patients were able to request a GP to telephone them instead of attending the practice. The practice was proactive in offering on-line services as well as a full range of health promotion and screening that reflected the needs for this age group. The practice offered extended opening hours on four evenings each week to support this group of patients.

Updated 23 April 2015

The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as requires improvement for safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as requires improvement for patients experiencing poor mental health (including patients with dementia).

The practice had a lead GP for mental health and held a register of patients experiencing poor mental health and those with learning disabilities. We saw evidence of effective collaboration and information sharing with community mental health services. The practice had sign-posted patients experiencing poor mental health to various support groups and local organisations.

Updated 23 April 2015

The provider was rated as good for caring and responsive overall and this includes for this population group. The provider was rated as requires improvement for safe, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as requires improvement for patients whose circumstances may make them vulnerable.

The practice worked closely with community services to enable an improved continuity of care for their housebound patients. The practice regularly worked with multi-disciplinary teams in the case management of adults and children who were vulnerable. The practice had signposted these patients to various support groups and voluntary sector organisations. Staff had some understanding of how to recognise signs of abuse in vulnerable adults and children. GPs were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in and out of hours. The practice provided support to patients who were registered as a carer.