The Care Quality Commission
  • Doctor
  • GP practice

The Chesser Surgery

Overall: Requires improvement read more about inspection ratings

121 Wrythe Lane, Carshalton, Surrey, SM5 2RT (020) 8644 2727

Provided and run by:
The Chesser Surgery

All Inspections

During an assessment under our new approach

Date of assessment: 8 and 9 August 2024. The Chesser Surgery is an NHS GP practice located in South London. The practice scored six on the deprivation measurement scale. The scale goes from one to 10 with one being the most deprived. There were over 6,000 people registered with the service at the time of our assessment. We conducted this assessment due to receiving information of concern. For this assessment we focused on the three key questions of safe, effective, and well-led. The ratings for the Caring and Responsive key questions were carried through from the previous inspection. At this assessment, we found that the practice provided safe and effective services and had adequate protocols and procedures in place. However, we found that staffing levels were not sufficient and not all staff had completed mandatory training. We also found that infection control protocols were not always followed, and not all prescribed medicines were being monitored in line with national guidelines. In addition to this, medicines reviews were not always documented. The provider could not demonstrate there was an effective freedom to speak up protocol in place. We also found that governance processes in place had not ensured that safe and effective care were being provided. We found breaches of regulation in relation to safe care and treatment, governance and staffing. We have asked the provider for an action plan in response to the concerns found at this assessment.

4 October 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Chesser Surgery on 4th October 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed with the exception of health and safety risk assessment of the premises ; however the practice held a risk register and monitored risks for both staff and patients.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • 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; however the provider was not sending response letters to all patients who had lodged a complaint.
  • Patients 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. However patients reported experiencing long waits when they attended for appointments.
  • The practice had good facilities and was 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.

There were areas of practice where the provider should make improvements:

  • Review practice procedures to ensure all the recommendations from the legionella risk assessment are actioned.
  • Ensure that a health and safety risk assessment of the premises is undertaken and that sharps bins are safely stored.
  • Review practice procedures to ensure all prescribed medicines are linked to patient problems in patients’ medical notes in the clinical system.
  • Review how they inform patients of any late running of the surgeries and work to reduce the length of time patients have to wait to be seen.
  • Review how patients with caring responsibilities are identified to ensure information, advice and support is made available to them.
  • Review practice procedures to ensure response letters are sent to all patients who had lodged a complaint.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice