The Care Quality Commission
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  • GP practice

Archived: Connaught Surgery

Overall: Good read more about inspection ratings

144 Hedge Lane, Palmers Green, London, N13 5ST (020) 8920 9606

Provided and run by:
Connaught Surgery

Important: The provider of this service changed. See new profile
Important: The provider of this service changed. See new profile

All Inspections

13 July 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Connaught Surgery on 21 December 2016. During the inspection we identified a range of concerns including an absence of staff pre-employment checks and systems in place to ensure the safe storage of vaccines. (The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Connaught Surgery on our website at www.cqc.org.uk).The overall rating for the practice was requires improvement.

An announced comprehensive inspection was undertaken on 13 July 2017. Overall the practice is now rated as good.

Our key findings of our inspection of Connaught Surgery were as follows:

  • Action had been taken to address failings regarding the safe storage of medicines in that the provider had replaced a domestic fridge which was being used to store vaccines with a new validated medicines fridge.

  • Action had been taken to address failings with the practice’s system of undertaking pre-employment checks. Staff personnel records we reviewed contained the necessary pre-employment checks in accordance with the practice’s recently revised recruitment policy.

  • Action had been taken to improve governance arrangements in areas such as quality improvement and risk management, such that the arrangements now facilitated the delivery of high quality person-centred care.

  • Clinical audit was being used to drive quality improvement.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

  • Data from the national GP patient survey showed that the practice performed well in several aspects of care. For example, all of the 114 patients interviewed as part of the GP national patient survey said they had confidence and trust in the last nurse they saw.

  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Continue to monitor arrangements for managing blood test results, so as to ensure that the system is robust, effective and safe.

  • Ensure that water temperature monitoring takes place to control the risk from legionella (a term for a particular bacterium which can contaminate water systems in buildings).

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

28 July 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Connaught Surgery on 28 July 2016. Overall the practice is rated as requires improvement.

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

  • The practice was unable to provide evidence that all staff had undergone all necessary pre-employment checks.
  • The practice was not using care plans for patients with long-term conditions. Care plans set out how the care and support needs of each patient within specific groups will be met.
  • Although staff had personnel records these were not stored in separate folders, and were not kept up to date, much of the information we would expect to find was missing including evidence that staff had undertaken mandatory training. There was also a lack of evidence to confirm that all staff had undergone an appraisal within the last 12 months.
  • A domestic fridge was being used to store vaccines rather than a validated medicines fridge which must be used for the storage of vaccines and other medicines.
  • There was an effective system in place for reporting and recording significant events.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was generally well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

  • Ensure the procedure for all staff recruitment includes undertaking all relevant pre-employment checks to verify that staff are of good character and have the qualifications, competence, skills and experience necessary for them to discharge their role.

  • Ensure all staff are kept up to date with mandatory training in line with national guidance and guidelines and that appropriate records of this are maintained.

  • Ensure that all vaccines are stored safely in an appropriate medicines fridge, and that the fridge is not overstocked.

In addition the provider should:

  • Consider installation of a hearing loop in reception for the benefit of patients with impaired hearing.

  • Consider conducting fire drills so staff know what to do in the event of a fire.

  • Introduce a system to monitor and keep secure in use prescription pads and loose prescription forms.

  • Consider the use of care plans to ensure it meets the needs of patients with long term conditions.

  • Implement an audit programme so that all clinical audits demonstrate a two audit cycle to support quality improvement for patient outcomes.

  • Consider re-decorating the inside and outside of the building.

  • Consider how to implement, monitor and review actions identified to improve care for patients with diabetes.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

3 and 4 June 2014

During a routine inspection

Connaught Surgery is located in Palmers Green, North London. The practice served a diverse population with low deprivation and a high proportion of elderly patients. The practice delivered primary medical services to approximately 4,400 patients and is registered to provide the following regulated activities which we inspected: diagnostic and screening procedures, family planning, surgical procedures and treatment of disease and disorder or injury and serves. It is operated by two GP partners (one female, one male), a Practice Nurse, a Practice Manager and a team of reception and administration staff. The practice also supported year 4 & 5 medical students from a London medical school.

We saw that the service provided was safe, effective, responsive, caring and well-led, but there were some shortfalls. All of the patients that we spoke to and those who completed comment cards said the service they received at Connaught Surgery was either good, very good or excellent. Patients spoke  fondly of all the staff at Connaught Surgery. Despite the fact the practice had seen an increase in its patient list size of 25% over the last three years, patients said they were able to access both face to face and telephone appointments relatively easily. The practice offered an extended hours service and patients valued this arrangement. We saw that staff responded to urgent appointment requests wherever possible. Out of hours, patients could access care through the national 111 emergency service.

We saw that the service provided was safe, effective, responsive, caring and well-led, but there were some shortfalls. All of the patients that we spoke to and those who completed comment cards said the service they received at Connaught Surgery was either good, very good or excellent. Patients spoke fondly of all the staff at Connaught Surgery. Despite the fact the practice had seen an increase in its patient list size of 25% over the last three years, patients said they were able to access both face to face and telephone appointments relatively easily. The practice offered an extended hours service and patients valued this arrangement. We saw that staff responded to urgent appointment requests wherever possible. Out of hours, patients could access care through the national 111 emergency service.

The service understood the needs of its patient population and were increasingly improving patient outcomes including those for older people, people with long term conditions, mothers, babies, children and young people, the working age populations and those recently retired, people in vulnerable circumstances and people experiencing poor mental health.

We found specific care pathways in place for patients with long term conditions such as diabetes or high blood pressure. Patients care management included referral to other healthcare professionals in both primary and secondary care in a timely way. We found that patients received safe care and they were protected from abuse because staff received appropriate training and the practice had systems in place for safeguarding of vulnerable adults and children. The practice had effective systems in place and patients were protected from the risks associated with infection prevention and control and medicines were safely managed. Some areas of the premises required repair and redecoration including the reception area, the public toilet and the mother and baby reception area. There were effective relationships with district nurses, care homes and local pharmacies.

We did note some areas which required improvement and we have told the practice to take action on these matters. Staff had not received training in the requirements of the Mental Capacity Act (2005) Clinical staff did not demonstrate knowledge of the requirements for consent to treatment, in keeping with best-practice and this had the potential to impact on patients who lacked capacity. The practice had a number of mechanisms in place to report and record safety.