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Reports


Review carried out on 19 July 2019

During an annual regulatory review

We reviewed the information available to us about Eastview Surgery on 19 July 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 30 August 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eastview Surgery on 19 November 2015. The overall rating for the practice was requires improvement and requirement notices were made as improvements were needed in safeguarding, suitability of the premises and to governance systems. The full comprehensive report on the November 2015 inspection can be found by selecting the ‘all reports’ link for Eastview Surgery on our website at www.cqc.org.uk.

This inspection was undertaken on 30 August 2017 and was an announced comprehensive inspection.

Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There were systems in place to reduce risks to patient safety, for example, equipment checks were carried out, there were systems to protect patients from the risks associated with insufficient staffing levels and to prevent the spread of infection.

  • Staff were trained, understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.

  • Staff felt supported. They had access to training and development opportunities appropriate to their roles.

  • Patients said they were treated with compassion, dignity and respect. We saw staff treated patients with kindness and respect.

  • Services were planned and delivered to take into account the needs of different and diverse patient groups.

  • Access to the service was monitored to ensure it met the needs of patients.

  • There was a system in place to manage complaints.

  • There were systems in place to monitor and improve quality and identify risk.

  • The premises and equipment were clean and suitable for use.

However, there are areas of practice where the provider should make improvements:

  • Review the system for reviewing significant events and complaints on a regular basis in order to identify themes and trends and learn from these.

  • Review the system for documenting action taken in response to patient safety alerts.

  • Review policies and procedures to ensure they are up to date and specific to the practice.

  • Implement a schedule for cleaning of clinical equipment and formal monitoring of the general housekeeping cleaning schedules.

  • Implement a quality improvement programme which includes clinical audits being undertaken in response to local and national priorities. This should include infection prevention and control audits undertaken annually.

  • Review communication with the patient participation group to actively encourage seeking feedback from this means.

  • Review health and safety procedures to ensure that risks are assessed fully and control measures are in place and monitored.

  • Implement a system for checking the validity of professional registrations for clinical staff

  • Review and monitor the training plan for clinical and non-clinical staff to ensure all staff continue to be updated in their required training specific to their roles.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 19 November 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eastview Surgery on 19 November 2015. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Risks to patients were assessed and managed, however the practice did not meet its responsibilities in the provision of reports for child safeguarding review boards.
  • Areas highlighted for improvement in an infection control audit in September 2015 had still not been addressed. We found a GP consulting room to be cluttered, one consultation room had soiled, discoloured blinds in place and some areas above sinks required attention.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver required care and treatment.
  • The practice had undertaken a number of clinical audits which were used to drive improvement, but findings were not always shared with colleagues. Also the majority of audits we reviewed did not consist of completed cycles.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Feedback from patients was mixed; some said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day. Others said they found it hard to get through to the practice by phone.
  • The practice had a number of policies and procedures to govern activity and these were accessible to all staff
  • The practice had an active patient participation group who contributed to suggestions on improvements for patient experience at the practice.
  • Leadership required improvement. There were no clear plans in place to address how the building would be maintained and when it would be adapted to provide treatment rooms that met infection control requirements. The practice did not readily adopt new ways of working which improved the patient journey between primary and secondary care.

The areas where the provider must make improvements are:

  • In the submission of safeguarding reports, to child safeguarding review boards, in the required format.

  • In the development and maintainence of the practice premises to meet required infection control standards.

In addition the provider should:

  • Ensure audits started are completed and meet the clear definition of an audit cycle.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice