We carried out a review of the data available to us about Alton Surgery on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Alton Surgery, you can give feedback on this service.
We previously carried out an announced comprehensive inspection at Alton Surgery on 13 June 2017. The overall rating for the practice was good with requires improvement in providing safe services. As a result, we issued two requirement notices in relation to safe care and treatment and fit and proper persons employed. We carried out an announced focused inspection on 17 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the regulation breaches. We found that there were ongoing breaches of these regulations and a further breach in staffing. The overall rating remained good with requires improvement in safe services. We carried out an announced comprehensive inspection on 16 March 2018 and found all of the required improvements had not been made. We rated the practice good overall and requires improvement in well-led. We issued a requirement notice in relation to good governance. The reports on the 13 June 2017, 17 October 2017 and 16 March 2018 can be found by selecting the ‘all reports’ link for Alton Surgery on our website at www.cqc.org.uk .
We carried out an announced focused inspection at Alton Surgery on 15 January 2019 to ensure that the required changes had been made.
We based our judgement of the quality of care at this service on a combination of:
•what we found when we inspected
•information from our ongoing monitoring of data about services and
•information from the provider, patients, the public and other organisations.
We rated this practice as good overall.
We found that:
The areas where the provider should make improvements are:
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
We previously carried out an announced comprehensive inspection at Alton Surgery on 13 June 2017. The overall rating for the practice was good with requires improvement in providing safe services. As a result we issued two requirement notices in relation to safe care and treatment and fit and proper persons employed. We carried out an announced focused inspection on 17 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the regulation breaches. We found that there were ongoing breaches of these regulations and a further breach in staffing. The overall rating remained good with requires improvement in safe services. The reports on the 13 June 2017 and 17 October 2017 can be found by selecting the ‘all reports’ link for Alton Surgery on our website at www.cqc.org.uk.
This inspection was an announced comprehensive inspection carried out on 16 March 2018 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 on 17 October 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Overall the practice is now rated as good with requires improvement in well led services.
Our key findings were as follows:
There was a system in place for reporting and recording significant events. Staff understood their duty to raise concerns and report incidents and near misses. However, opportunities to improve identified ongoing errors had not been fully explored or addressed.
Non-clinical staff had not received training to identify the rapidly deteriorating patient or the actions to take.
Staff understood their responsibilities in safeguarding children and vulnerable adults from the risk of abuse. The practice told us they held three monthly safeguarding meetings at the practice to discuss safeguarding concerns, however the outcome of these meetings was not recorded.
There were standard operating procedures (SOPs) to support the governance and effectiveness of the practice’s dispensary and openness and honesty in the reporting of dispensing errors. However, opportunities to reduce errors were not always taken.
Staff were aware of current evidence based guidance.
A formal system to ensure that professional registrations were in date had been implemented.
A system of support and mentorship for nurses that prescribed had been implemented.
Staff involved and treated patients with compassion, kindness, dignity and respect. The practice achieved high levels of patient satisfaction which were above local and national averages in all areas of their performance.
Patients found the appointment system very easy to use and reported that they were able to access care when they needed it.
The practice worked proactively with the patient participation group to meet the needs of their patients.
There were clear responsibilities, roles and systems of accountability to support governance. However, policies and practice administration did not always provide assurance they were operating as intended.
The service was not always transparent, open and honest when sharing information with the Care Quality Commission.
However, there were areas of practice where the provider needs to make improvements.
The provider must:
In addition the provider should:
Document the three monthly safeguarding meetings held at the practice to provide an audit trail of concerns and action taken.
Provide non-clinical staff with training to identify the rapidly deteriorating patient and the actions to take.
Chief Inspector of General Practice
We previously carried out an announced comprehensive inspection at Alton Surgery on 13 June 2017. The overall rating for the practice was good with requires improvement in providing safe services. As a result we issued two requirement notices in relation to:
The full comprehensive report on the 13 June 2017 can be found by selecting the ‘all reports’ link for Alton Surgery on our website at www.cqc.org.uk.
This inspection was an announced focused inspection carried out on 17 October 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 on 13 June 2017. This report covers our findings in relation to those requirements.
Overall the practice is now rated as good with requires improvement in providing safe services.
Our key findings were as follows:
However, there were areas of practice where the provider needs to make improvements.
Importantly, the provider must:
Ensure care and treatment is provided in a safe way to patients. In particular, risks identified at our previous inspection were not risk assessed until the day of this inspection. A risk assessment to reflect guidance from The Control of Substances Hazardous to Health Regulations 2002 (COSHH) in relation to the storage or spillage of mercury had not been completed.
Ensure persons employed in the provision of the regulated activity receive the appropriate support, professional development and supervision necessary to enable them to carry out the duties.
Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
At our previous inspection on 13 June 2017, we rated the practice as requires improvement for providing safe services. This was because:
The registered person had not ensured that specified recruitment information was available regarding each person employed.
The registered person had not done all that was reasonably practicable to mitigate risks to the health and safety of service users receiving care and treatment.
At this inspection we found ongoing gaps in specified recruitment information regarding each person employed and action to mitigate risks had not been taken or was not taken until the day of our inspection.
At our previous inspection we also advised that the provider should:
Complete a risk assessment to reflect guidance from The Control of Substances Hazardous to Health Regulations 2002 (COSHH) in relation to the storage or spillage of mercury.
Introduce a formal system of support and mentorship for nurses who prescribe.
Neither of these two recommendations had been implemented.
Consequently, the practice is still rated as requires improvement for providing safe services.
Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Alton Surgery on 13 June 2017. Overall the practice is rated as good.
Our key findings across all the areas we inspected were as follows:
Staff were aware of current evidence based guidance.
Systems were not in place to protect patients from potential health care associated infections.
Some staff were not aware of the manufactures’ temperature range guidelines in which medicines must be stored. Action had not been taken immediately to address issues identified.
Specified recruitment information was not available regarding every person employed at the practice.
Risk assessments of the emergency medicines that should be held at the practice had not been completed to demonstrate how patients would be kept safe in the absence of several emergency medicines.
A comprehensive business continuity plan for managing major incidents was not in place.
A risk assessment to reflect guidance from The Control of Substances Hazardous to Health Regulations 2002 (COSHH) in relation to the storage or spillage of mercury had not been completed.
Feedback from patients about their care was very positive.
We saw two areas of outstanding practice:
The practice had won an award from the National GP Patient Survey achieving the highest patient satisfaction ratings in England. The practice had achieved 100% patient satisfaction in many areas of their performance.
Data showed 100% satisfaction with patient access to appointments. As a result of the practice’s approach to offering quick and easy access to appointments they had the lowest A&E attendance rate within GP opening hours within the local Clinical Commissioning Group (CCG). Data over three years showed a consistent year on year decrease in this rate.
The areas where the provider must make improvement are:
Ensure that systems are in place to protect patients from potential health care associated infections by the provision of immunisations for staff, risk assessments and appropriate screening.
Ensure that staff are aware of manufactures’ temperature range guidelines in which medicines must be stored and that action is taken immediately to address any issues identified.
Ensure specified recruitment information is available regarding each person employed.
Ensure persons employed in the provision of the regulated activity receive the appropriate training necessary to enable them to carry out their duties.
Introduce systems to risk assess the emergency medicines that should be held at the practice.
Develop a comprehensive business continuity plan for major incidents.
The areas where the provider should make improvement are:
Complete a risk assessment to reflect guidance from The Control of Substances Hazardous to Health Regulations 2002 (COSHH) in relation to the storage or spillage of mercury.
Introduce a formal system of support and mentorship for nurses who prescribe.
Chief Inspector of General Practice