Surgery Inspections

During an inspection, the question asked by the Care Quality Commission is “is it safe?” but when it comes to standards of accommodation, things have changed dramatically over the years.

In the 1950s consulting rooms were cluttered but basically furnished with old-fashioned roll-top desks for the doctors. During the 1970s and 80s when I inspected surgeries in the West Midlands and West Yorkshire the main things I looked for were hot and cold running water and a screened couch in the consulting room, and maybe toilet facilities for patient but that was about it. Computers were rare then and record keeping was relaxed. In fact, one GP in Hertfordshire kept patient records in his car boot!

From too small to too large

From 1966 onwards, the Red Book – or Statement of Fees and Allowances – set guidelines for Standards of Accommodation, which were used to approve hundreds of new surgeries or to make improvements to existing ones around the country. However, the impractical design of health centres built in the 1960s means that these are no longer serviceable. Even the new ‘maxi’ surgeries built under the Private Finance Initiative schemes are becoming white elephants simply due to their size. The expense of keeping up these surgeries, plus the added worry of keeping them ‘safe’, is unaffordable for many young GPs, and investment is running out for all but what I call pet projects like minor surgical procedures which do nothing for the structure and safety of the surgery.

When developing modern surgeries doctors were told to think big. Spare consulting rooms, bigger waiting rooms, more offices, extra patient facilities were all included but now even this is not enough and buildings are getting ever larger. But these premises are commonly owned by private landlords who lease the premises to GPs and levy expensive service charges.

New Technology and Security

Modern GP surgeries, like any businesses, must have up to date telephone and data systems, burglar and fire alarms, CCTV, emergency lighting and safety ladders to name but a few. In short, all the usual health and safety requirements must be present, and they all have to be properly maintained and serviced. This all costs a huge amount of money of course, but do they add to the safety of the surgery and its services?

A few years ago GP surgeries routinely suffered from what we would call security incidents – drivers blocking the car park, children playing around the premises, drunken patients causing trouble. So ‘security’ has become a vital cog in the surgery safety machine.

Is it clean?

Cleanliness has added another bureaucratic layer to the running of a GP surgery. Is the surgery cleaned daily to the required standard? Are vaccine refrigerators running at the correct temperature? Have infection control and risk assessment procedures been acted upon? The point is this though – does all the checking of toilet rolls and waiting room magazines reflect the safety of the Practice?

Or are patients more concerned with how soon they can get an appointment and are there enough staff on duty to provide a proper service? Are consultations carried out with proper care and consideration with patient records reflecting accurately the policies, protocols and procedures deemed essential by the CQC?

It seems that doctors nowadays have to provide not only a clinical service but also one that is safe and in a safe environment!

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