Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection of Dr Roy Alexander in June 2016. . The overall rating for the practice was requires improvement. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Roy Alexander on our website at www.cqc.org.uk.
This inspection was an announced comprehensive inspection carried out on 29 January 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 in June 2016. 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 Inadequate.
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Requires improvement
Are services caring? – Requires improvement
Are services responsive? – Good
Are services well-led? – Inadequate
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Inadequate
People with long-term conditions – Inadequate
Families, children and young people – Inadequate
Working age people (including those retired and students – Inadequate
People whose circumstances may make them vulnerable – Inadequate
People experiencing poor mental health (including people with dementia) – Inadequate
At this inspection we found:
- Although systems were in place to enable staff to report and record significant events, during our inspection the practice could not demonstrate that all significant events were reported or recorded.
- Patients were potentially at risk of harm because systems were not operated effectively to keep patients safe including those for dealing with safety alerts.
- A fire risk assessment had been undertaken in 2016; however parts of the assessment had not been completed.
- Prescription stationery was not stored securely and was not tracked in line with guidance.
- The practice had regular meetings with the health visitor to enable joint working, discussion and review of children at risk. However, the practice could not provide a copy of a child safeguarding policy and non-clinical staff had not received safeguarding training.
- Systems to ensure the security of controlled drugs were not being operated effectively. Arrangements to respond to emergencies needed to be reviewed and improved.
- There were limited processes in place for disseminating guidance from the National Institute of Health and Care Excellence (NICE) and local guidelines. Clinical meetings were not held within the practice.
- There was limited evidence to demonstrate quality improvement. Although some audits had been undertaken; there had been no two-cycle audits completed where improvements had been made and the monitored.
- Data from the Quality and Outcomes Framework highlighted areas where improvements were required.
- Information about services and how to complain was available and easy to understand.
- Policies and processes needed to be reviewed to ensure these were fit for purpose and being operated effectively.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Evidence provided during our inspection indicated that service improvement was not a priority amongst leaders. For example there was no evidence of action being taken to address below average satisfaction scores for consultations with GPs.
The areas where the provider must make improvements as they are in breach of regulations are:
- Ensure care and treatment is provided in a safe way to patients
- Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
The areas where the provider should make improvements are:
- Review and improve arrangements for the identification of carers in order to offer them with support where needed
- Review the practice website to ensure content is up to date
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice