Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection of Dr N Essa and Dr M Harrold (also known locally as London Street Surgery), on the 13 April 2016. We carried out this inspection to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made.
Our previous inspection in August 2015 found breaches of regulations relating to the safe, effective and responsive delivery of services. There were also concerns and regulatory breaches relating to the management and leadership of the practice, specifically in the well led domain. The overall rating of the practice in August 2015 was inadequate and the practice was placed into special measures for six months. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance.
At the inspection in April 2016, we found the practice had made significant improvements since our last inspection in August 2015. Specifically, we found the practice to require improvement for the provision of a safe, caring and well led services. It was good for providing effective and responsive services. However, the practice was required to make further improvements and rated as ‘requires improvement’ overall.
Our key findings across all the areas we inspected were as follows:
- All the partners and staff worked hard to undertake a complete review of the service since the previous inspection and made sustainable improvements.
- Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The majority of information about safety was recorded. However, lessons learned from significant events and incidents were not always communicated widely enough to support improvement.
- Risks to patients were assessed and well managed in some areas, with the exception of those relating to recruitment checks, safeguarding training and management of legionella. For example, Disclosure and Barring Scheme (DBS) checks or risk assessment were not carried out for a non-clinical staff undertaking chaperoning duties.
- We found that completed clinical audits cycles were driving positive outcomes for 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.
- Results from the national GP patient survey showed majority of patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment when compared to the local and national averages. The majority of patients we spoke with on the day of inspection confirmed this. However, not all felt cared for, supported and listened to.
- Information about services and how to complain were available and easy to understand.
- Patients said they found it easy to make an appointment with a named GP and there was continuity of care. Urgent and online appointments were available the same day.
- 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 provider was aware of and complied with the requirements of the Duty of Candour.
- The practice had improved their governance arrangements since previous CQC inspection. However, the practice was required to make further improvements to ensure continuous monitoring and assessment of the quality of the service.
The areas where the provider must make improvements are:
- Review the process for implementing change following incidents and significant events to ensure actions are completed. Improve the recording of discussions and actions during practice meetings.
- Ensure all actions required in response to national safety and medicines alerts are completed and disseminated within the practice.
- Ensure all necessary recruitment checks are in place including systems for assessing and monitoring risks, carrying out Disclosure and Barring Scheme (DBS) checks or risk assessment.
- Review patients feedback and address concerns regarding GPs listening, giving enough time, involving in decisions, explaining tests and treatments, and treating them with care and concern during consultations.
- Further review and monitor the governance arrangements in place to ensure the delivery of safe and effective services. For example, monitoring of non-emergency medicines, accessibility of emergency equipment, management of legionella and awareness of emergency alert system during consultations.
In addition the provider should:
- Ensure Patient Group Directions (PGDs) are renewed before they expire to allow nurses to administer medicines in line with legislation.
- Ensure development areas identified during appraisals are followed up and monitored systematically.
- Review the system in place to promote the benefits of cervical and bowel screening to increase patient uptake. Provide information in appropriate languages and formats.
- Ensure routine health checks are undertaken for patients aged 40 to 74 years old.
- Encourage carers to register as such to enable them to access the support available via the practice and external agencies.
- Develop and implement clear action plans, to improve the outcomes for learning disabilities patients.
I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service. We will inspect this service again in future to check the practice has made further improvements.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice